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My first thought too would be that the school staff does not realize that the signs for all the mentioned diagnoses (PDD, Asperger's, Anxiety, ...) could also be big signs for giftedness. When they see "trouble" they think in negative terms rather than finding out what's really behind it. Especially if the neuropsych didn't see it.

Wow. I guess my gut says--that is too many things to come back high on. The teachers are just scoring her high on every negative measure out there. This may mean she is really shut down, but how could she really have ALL that? Do you feel like the environment is very toxic to her?

I would absolutely want data to support the judgments in the report. What standardized assessments were done?


Task initiation is getting going on a task; very hard for people who have ADHD, not usually impaired in people with anxiety AFAIK. People who have impaired initiation often show a frustrating gap between the time they are given an instruction and the time they actually acknowledge it or start to complete it. It can make a child look oppositional even if it's really a processing glitch.

Executive function issues (often associated with ASDs and ADHD) show in a lot of ways, but the gist is that it's the skill set that lets you stay on task from start to finish without wandering off, lets you bring yourself back to your task if you are temporarily distracted, etc. It's the command-and-control center for getting things done.


IME, EF-challenged people do find standardized tests exhausting and annoying. They require a high level of attention and control of one's own brain. To get accurate results, your DD may need tests chopped into smaller pieces over more days.


The EF stuff can look baffling and be very aggravating to adults in a school setting, who spend tons of time giving instructions and expect immediate compliance. Here is a kid who has the brains to comply, and yet she doesn't comply, so it can look like conduct disorder etc. Also frustrating for the kid, because even if she wants to comply her get-going skills may not be letting her do it, and she lands in trouble all the time.

I wonder if you can find someone (sometimes called "educational therapist") to work on the EF problems specifically and see if the other things improve.

What is he suggesting for the anxiety?

Did he do any testing that would reveal deficits in perspective-taking skills? (ADOS?) I wouldn't be eager to do a group social skills class for this kid unless it was clear to me what skills were lacking and that these were the precise skills that would be addressed.

DeeDee

I kind of disagree with this, though. As I've said before, I am not a big fan of definitions of giftedness that paper over behavioral struggles (Dabrowski etc.). Most gifted kids IME do not show serious behavior struggles of this kind; and ignoring the struggles can mean that another exceptionality goes unaddressed, when addressing it can improve quality of life.

All the more reason to get to the bottom of what's going on.

DeeDee

I'm just thinking that I'd rather take the neuropsych's opinion than the school who's usually too fast to label? Personally, as I child, I would had been labeled ADD, Asperger's, OCD with severe social Anxiety to say the least but I never did (wasn't something that was done back then). But in the end I just turned out to be gifted with some social Anxiety but nothing I couldn't keep under control.

Maybe get further evaluation and / or second opinion???

Actually I think that the phrase "barely 2e" describes the data in the NEPSY - one thing about neuropsychs that can be a bit frustrating and confusing is they will usually describe the data they collect in a very specific way according to how the data should be described - for instance, when they use descriptive words rather than numbers to describe WISC results they use terms such as "superior" "very superior" etc that are actually defined for a specific range of numbers. When you look at your dd's NEPSY scores, they are all consistently very high except for "Word Generation" which is within the average range (on the lower side, 10 is the middle of the bell curve for NEPSY subtests). So techically speaking, that really does seem to describe a "barely 2e" situation when you look at WPSSI (I looked at your past posts, you posted it as 149), WJ-III (all high numbers except for handwriting (50th percentile) and unable to complete the math test, and NEPSY (all high numbers except word generation).

One thing that I wonder about is could the lower scores on word generation, handwriting, and inability to complete the math test on the WJ-III be tied together in some way.

I'm not sure, but have you posted your dd's WPSSI subtest results here? Was there any scatter?


Anxiety is a diagnosis, and it can be very real. Is it *the* diagnosis for your dd? It's possible that only time will tell. Many of us here with children with challenges have found that there isn't one definitive report from one professional that gives you the definitive answer and sets the path forward in stone.


You actually do have a lot of data here, and a 100 pages long report most likely contains quite a bit of observations from the tester. The trick is putting it all together with your observations of your dd's challenges and making sense of it. Chances are it's not going to neatly all fall together with one report and be completely clear, but as you go forward, you've now got this extra information to collate with what you already know about your dd and I'm guessing that as you have time to let the report sink in and think it through you'll find that some of it makes sense, maybe some of it doesn't, but it will help give you direction for what you need to do next.



Have you had a follow-up interview with the neuropsych after receiving the report? If you haven't, schedule one. It has always helped me tremendously to read the report, let the results sink in, and then meet with the neuropsych one on one to ask questions I have. For me, that interview usually gives me so much *more* to think about that I schedule a second interview a few weeks later just to make sure I get all my questions answered.


They are! Which is good news But - having all scores be incredibly fine and one little score be less than optimal (or even average for HG/+ kiddos... can be *extremely* challenging depending on the nature of the challenge. Another thing - you can't *just* look at the NEPSY scores to get a full picture of your dd's functioning, you need to look at NEPSY+WPSSI+WJ-III... and there is something low in at least the NEPSY + WJ-III.... so I'd ask the neuropsych if they are possibly related.



Which math subtest was it? How is it administered (oral response, written, did she have to read the directions, things like that - plus what specific skill was it measuring, and was it the last test or was it given somewhere in the middle?).

If it wasn't the last test given after a long block of tests, and if there wasn't some type of anxiety trigger noted by the neuropsych, I'd really wonder if there wasn't some type of challenge causing frustration for your dd directly related to that test in some way - her other tests are so consistently high across the board it's clear that she was having a good test day, that she wasn't across the board anxious, and she must have had a somewhat good rapport with the neuropsych.


Her teachers are not psychiatrists/psychologists/medical drs/etc. They are teachers. They are seeing a little girl who's clearly having challenges at school, and that's going to be reflected in the surveys they are given as part of a neuropsych eval. I think what you have to do at this point is simply acknowledge something is up, and it's not clear, and the teacher/caregiver input *is* all over the place at this point. It doesn't point in one specific direction, but it indicates your dd needs help.


It really helps me to think of input like this as simply data, rather than good or not good. It's actually a good thing to have data - even if it seems depressing on the surface.


I would give his recommendations a try - the first step is simply calling the people he's referred you to and asking them questions about what their therapies would involve. If it sounds reasonable and like it makes sense for your dd, you can try them out and if they seem to work, keep at it, if they aren't working, drop it. Along the way, you'll be collecting more data, and you may also find things help.


Sending you a huge hug - this is simply one point in your journey, and you're doing exactly what you need to do for your dd - trying to find answers and trying to put together meaningful help. Things will look better as you move forward. I will never forget how I felt when we received our ds' first neuropsych report - the neuropsych used the words "his disability" in passing, they just flew out of her mouth very casually and the pit of my stomach literally fell through the floor - I'd never in a million years thought I would be parenting a child with a "disability" (please know I'm not a shallow person! It just wasn't on my radar... and I'd spent 8 years at that point raising a child who was clearly exceptionally intellectually gifted.. and yes, at that point in time, I had no idea the two could coincide)... so I'm just mentioning that because I've been in that spot where suddenly things seem very grim... and really it *does* get better.

Best wishes,

polarbear

ps - I'll second all of DeeDee's advice

...although, clearly, your daughter had difficulty with the neuropsych, too? That is, sounds like she was oppositional in some way? Is she oppositional with you and your spouse? Can her behavior be okay under the right circumstances? I reread some back posts and I find it hard to imagine exactly what is going on, but I am intrigued, and also I feel for you. (My DD can also be oppositional and shows/has shown signs of ADHD, ASD, ODD....she is also very good at pushing adults' buttons and outwitting adults, and is becoming a fast and accomplished liar, which is not looking very ASD, I must say...)

ETA that the only diagnoses she has at this point are anxiety and depression, though she has only been casually screened for ASD and ADHD (she did a computerized screener for that). I am looking at her behavior through the anxiety lens more and more these days with more and more "aha" moments. Anxiety is no cakewalk.

There are other types of reasons that task initiation (and word generation) might be impaired relative to overall EF and intelligence (outside of ADHD). And many of us here with 2e kids have their "impairments" show up as average range scores on tests like the NEPSY/WISC/etc. It's the discrepancy in scores (high to low) that means something, not the absolute number - other than in the technical description in the report. The type of number your dd has means that it is technically described as "mild". If I remember correctly my ds has #s on a NEPSY subtest that are 4 or 5 and his report description is "moderately impaired". Then in the summary section his neuropsych pulls all of his tests together and describes how they impact his functioning - and she uses the word "severe" there - but it's not tied to a specific test. And it is relatively severe - so I'm just offering that up as an example of - you can't get to hung up on the words used to describe the data as prescribed by professional guidelines... you need to look at how the whole child is functioning.

polarbear

ps - I was also surprised to read that high #s on the other EF skills rules out ADHD - I thought ADHD was usually assessed through surveys, and our neuropsych also had a computerized type of attention test she uses in her evals. I thought ADHD could be reflected in NEPSY scores, but didn't realize they could be used to rule out ADHD. BUT - I'm not a professional so my thoughts are pretty much meaningless and should be ignored on this!

I suspect the reason each teacher thought they saw a different diagnosis is due in large part to the fact they are teachers, not psychs trained in diagnosis. We've experienced some of the same thing, and what's happened with us is the teacher who has seen a lot of kids with ADHD diagnosis picks up on the symptoms that might be ADHD related (or look like it), and the counselor who has a large percentage of clients on the autism spectrum picked up on symptoms that might overlap with ASD diagnosis etc - so everyone who doesn't have the full expertise to diagnose is seeing what they know and extrapolating that to a suspected diagnosis.

polarbear