Gifted Issues Discussion homepage Forums Twice Exceptional Accurate evaluations with 2E symptoms?

So, DS7 is finishing up with evaluations at school for an IEP related to problems that he has been having with spectrum-ish/ADHD/anxiety issues. He has seen a private psychologist who has deferred any diagnosis to someone more "specialized" in gifted/2E kids but that's just not an option at the moment. So far the only thing that we know is that he has one or more of these diagnoses that may be causing symptoms of, or exacerbation of, any of the other possible diagnoses. Confusing, to say the least...

Yesterday, the school psychologist that has been doing his evaluations called to set up an appointment for a developmental interview. I asked her how the rest of the assessments have been going and she responded that he has been fun to work with and that his assessments have been "interesting". Now, I'm not in the mental health field but I do work in health care and "interesting" is usually a euphemism for "complicated" or "I give up, I don't know!"

My question is, considering that we're having these evaluations done because of problems at school (difficulty interacting with others, trouble with attention issues, anxiety/panic attacks etc...)could the problems themselves actually get in the way of a valid result on the assessments?

For example, the psychologist told me that his IQ test went "really well" the first day but "not so good" the second day. Apparently the second day he was up out of his seat, not paying attention, etc... His "overall" score (I don't have the breakdown yet) was 129 with some sub-tests higher (135+) and some lower. The first day was also the same day that he later developed a high fever and was diagnosed with strep throat.

They also administered an ADOS which she again described as "interesting" and then said that she probably wouldn't be able to actually score it. I understand the basics of the assessment (play based scenarios with the psychologist while someone else notes specific behaviors) but don't know specifics about it. The psychologist basically told me that he wouldn't 'play ball'. He wanted nothing to do with role playing and instead kept asking about the blocks from their previous session (the IQ test). She also said that he almost seemed 'angry' with her when she used toys for things other than their intended purpose. At one point she put a toy soldier on top of a toy UFO and said "Look, he's canoeing down the river." and the only thing he would do was glare at her and state "That is NOT a canoe."

I don't care if his IQ is 129 or 159. I don't care if he has Asperger's vs ADHD vs anxiety disorder. I just want to figure out how to help him. Does anyone else have experience with this kind of thing? I talk to the psych again tomorrow so maybe I'll get more info then but just hoping someone might have some insight.

Thanks

I think any type of anxiety is a by-product of the stress of being in a school environment that isn't a good fit and also possibly the child knowing they're different that other kids. Maybe your DS is 2E and that causes the inconsistences, but the way the testing is being communicated to you isn't very helpful or even professional.

I guess I'd suggest considering starting to work on finding suitable outside testing. My DD's very low processing speed is continuing to be a problem and in this new school, who had all her testing results (but no diagnosis since her strengths are so stong) it's like when I bring it up the words (spoken or written) literally evaporate. It's bizarre, it happened at the last school also. It's like they're scared of it because they don't understand, or just turn their nose up at it.

I'm strongly considering taking her to CTY this winter because other than that I haven't encountered any tester or anyone in her school that seem to understand the 2E concept. If anything it will finally give me some testing results that can made recommendations within a 2E framework.

School is not the best place for these types of kids, honestly. My DD is best suited to live on a farm, work all day, have constant contact with animals and in her free time have a barn full of junk to invent things with. Honestly! But she doesn't so we do our best. Now one of our pets has passed an evaluation for pet therapy so we're signed up to visit a nursing home once a week. My DD steered the whole thing, talking to neighbors with dogs etc. and helping with training. She's very excited.

My short term advice is to find out what your son is good at and just try to soak his non-school hours with things he feels proud of, and if possible things that put him in contact with adults outside school who get him or possibly appreciate him more. It will make him feel better and you also, and give you an alternative lense to see him in, because he needs your support and for you to be his champion.

Also make sure at least one thing that you find for him to do is social. My DD happens to love to sing and she's always successful in a choir/chorus. Musically people always get her, always (but not the teachery kind...the real working, emotional professional types)

We've had tons and tons of failures and I've gotten pretty discouraged sometimes but just had to think of something to try again, reading a new book about misdiagnosis or 2E, trying some other approach.

Thanks bzylzy-

We do try a lot of what you talk about with keeping him busy with things he enjoys outside of class, etc... but the thing is that he STILL has the same problems outside of the school as well. His anxiety/phobias have been around long before school started and while he will go participate in activities that he likes (T-ball, bowling, activities at the library, etc...) he still doesn't really interact with the other kids (or adults) very much and has a hard time focusing on anything.

I would love to home school him but its just not in the cards for at least a year or two.

As far as the method of communication, I am not too worried about that since she was mostly just making conversation. I asked her about how things were going and will get a formal report on everything when we sit down and do his IEP.

My question, again, is whether the 2E issues could be changing his test results. I feel pretty positive that the 129 IQ score is a minimal level from him (just from what I see of him at home). If it is accurate, I am fine with that but if its not how would we know and would it be worth retesting down the road when/if we are better able to manage his other issues?

MoN-

The psych actually sounds like she is at that "trying to figure him out" stage of things. I guess I'd rather she say 'He's really complicated and should see a specialist to tease out the individual diagnoses" than to just proclaim that he has "X" or "Y". As far as when its going to be possible to see a specialist, unfortunately it's not any time in the near future. I am going back to school for a year and DH is still finishing a degree. Insurance coverage, and cash in general, is going to be very minimal for the next 12-13 months.

sorry I didn't really answer your question. Yes I think 2E issues affect IQ. DD's had high 150s, low 120s and "we won't calculate because the gap between x and y is too large". The testers have all been different, the highest IQ from the most experienced one with the strongest background experience with gifted kids - but she still thought the low short term memory/processing speed wasn't an issue because the other areas were high enough for compensation.

The problem that she continues to have I believe IS the descrepancy and compensation needed CAUSES the frustrations... And the "this is interesting" and all that is getting tiresome, though I realize people don't mean anything bad by it.

Does he like LEGOs or building things? When they have those clubs the child is with other kids but you're more likely to get other kids that are happy building side by side and interacting in their own way...maybe not textbook "typical" but at least they share the same interest, and it's a break from the usual school/sports expectations - just a little relief time. My DD is extremely interactive, best with adults and older kids and likes to look after little ones..that's not a problem, it's just that she gets nervous when there is a larger group of kids her age and they look at her like she's from another planet. But she keeps trying anyway.

2E issues have definitely affected our son's IQ scores with either so much scatter the test isn't valid or with depressed scores that mask his Giftedness. But as master of none says, it really isn't a simple yes or no - there are so many factors that can affect the outcome.

As to treating without a diagnosis - what our psychiatrist has done is write a letter to include in his file that states that he is under observation and continued testing with no present diagnosis possible but with factors leaning towards the following - and then a list of possible diagnoses and a list of behaviors which need accommodations in the school setting. This has allowed us to get a better support system and environment in place without first slapping a label on him that may or may not be correct.

Good luck - it is a tough journey with no easy answers.

2E issues absolutely have affected our dd's IQ scoring: she has a 50 point verbal suppression related to her other subscores. (she was in second grade when those scores were determined; I'd be curious to see what they are now.) Mostly suppressed scores don;t work out to be quite that clearcut, but she's never been exactly a subtle child...

2E symptoms can impact the scores on IQ tests in two ways: if a child has varying strengths vs challenges due to 2E issues (gifted and LD etc)... the areas of strengths and areas of challenges are going to show up as scatter in subtest #s - it may not be something that a parent wants to see, but it's actually very useful information. The other way that 2E might potentially impact IQ scores is if it prevented the child from fully understanding what is asked on the test, or from showing his knowledge, or from cooperating, and when that happens the scores you'll see don't accurately reflect what your child's true abilities are.


When you meet with the psychologist, be sure to ask for the full report with subtest scores. Also ask which tests he took on which day, and try to figure out whether or not the behaviors noted on the second day were throughout all subtests, or were they on a specific set of subtests, or did they start with one subtest and then continue. You can ask at the meeting if the psych felt the behaviors started because of difficulty with answering the questions or if he just felt that ds was having a bad day etc - get the psych's opinion. Then, in addition to getting the psych's opinion, after the meeting, look through the specifics of each subtest where your ds struggled - what was the test asking him to do, how were the instructions given (oral or did he have to read them), what type of output was required (verbal response vs mark vs handwritten) etc.


Scatter in subtest scores is very typical for 2E kids. A general rule of thumb (according to my neuorpsych) is that scatter that is less than 1 SD is normal; scatter greater than 1.5 - 2 SD could indicate an area of challenge. I think most of us on the board with 2E kiddos see scatter greater than 2 SD and often greater than 3 SD.

Did the psych administer achievement testing also? It can also be very useful (in conjunction with the IQ test) in understanding how 2E is impacting your child or what the 2E issues are. If you have achievement test results, look for two things: does the overall average match somewhat with the results of the IQ testing, and is there significant scatter in the achievement subtest scores? If there is scatter, once again look at what specific skill the low scores were testing, how the question was asked, what response type was required etc.

Then you take all of that and review what's happening in the classroom and at home and see if anything makes any sense.


I have no idea what's up with your ds - but fwiw this sounds very much like the ds of one of my friends when he was your ds' age. I hope you have more help from the school district than my friend and her ds did - in my friend's situation, she was adamant that there was no "diagnosis" other than he was his own little person with a high IQ, and he's continuing to struggle. Your willingness to acknowledge there is possibly something more going on and your motivation to understand what's up is exactly what your ds needs - you may not get all your answers from this one set of testing (usually most 2e parents find that each set of testing provides some clues, some answers, and almost always a lot more questions)... but you are headed where you need to be heading.


I don't have experience with Asperger's or ADHD (other than an incorrect diagnosis for my ds and the occasional thought that my oldest dd might have ADHD)... but both of my 2e kiddos have suffered from severe anxiety at different times in their lives. For ds, the anxiety was all secondary to his LDs. When he was in 2nd grade and we weren't aware of them yet, his anxiety became so severe he was not sleeping at home, and having panic attacks both at school and at home. We had no idea at all that there was an LD, but once we found out what was really happening re the LD and school, and were able to put accommodations in place his anxiety disappeared. He's still (and will always be) the personality type that reacts to stress with anxiety, but the key for him was that the anxiety was (is) secondary and it's important to deal with what's causing the stress first, rather than dealing with the anxiety as primary.

My dd8, otoh, seems to live in a constant state of anxiety. We still don't have the answers for her - I'm sure part of it is related to her 2E challenges (she has difficulty with reading), but another part of it is, I believe, true anxiety in and of itself.

I am somewhat like you in that I don't care what the diagnosis is, I just want to help my children, but otoh, understanding the diagnosis, understanding what's up, has also been very crucial to being able to help. For instance, if we'd simply medicated our ds for anxiety symptoms when they first showed up, he would still be floundering/miserable today - anxiety wasn't the issue, an LD was the issue. A 2E child who has anxiety as a primary diagnosis might need medication to reduce the anxiety enough to allow them to work on the skills they need to compensate for an LD. As I'm sure you've heard before from other 2E parents, it's complicated, and it's a journey. You'll learn one thing and find another 18 questions - but those questions will lead to more knowledge, more questions, and on and on. It's frustrating at the start, but eventually you'll get to a place where you can look back and realize how much that initial digging for answers really does pay off.

Hope that helps some - let us know what you find out at your meeting.

polarbear

Okay, so DH and I just got done with the phone interview with the school psych. Mostly we were giving her more info but she did give us a little more info about his assessments as well. His IQ scores were as follows:
FSIQ 129
Verbal 114 (82 percentile)
Perceptual 135 (99 percentile)
Working memory 135 (99 percentile)
Processing Speed 88 (21 percentile)

The ADOS, as I mentioned before, was "complicated", to say the least, by DS's either refusal or inability to participate in parts of the screening. He wouldn't even look at the picture book that he was supposed to look at and say what was happening. He got angry with her for using toys for anything other than their intended purpose and just didn't, as she said, "play ball".

She also gave us some highlights from the Behavioral Assessments that his teachers (four of them) turned in. 'Acting Out' scored high from two teachers and at risk from two others. 'Internalizing/Anxiety' scored high from his primary teacher and at risk from one other. 'Rule Breaking' was a problem with three out of four teachers and 'Social Withdrawal' was considered high by two teachers and at risk by the other two.

I don't know what to make of any of this and she hasn't done her report yet except that obviously the processing speed score is a HUGE departure from the other scores. The verbal score was also surprising to me but it sounds like he wasn't being too cooperative there. She will complete that soon and we will get the complete report, scores, interpretations, etc after the Christmas break.

That is a red flag for autism spectrum disorders; does he play with toys in a "figurative" way at home?

I think private testing is a really good idea. If money's a problem there is usually a creative way to get funding for private testing. I'd call a specialist and see what they recommend; they are used to conversations about funding. Here there are several pots of county money that can pay for diagnostic work. Easter Seals also sometimes pays for this kind of thing.

DeeDee