Gifted Issues Discussion homepage Forums Twice Exceptional It can't be all of them, can it?

We're now a few months into getting services and I'm getting a lot of feedback and requests for more testing. We started with SPD and anxiety with a dash of OCD tendencies in 2010.

An OT evaluation wants her tested for autism (again) and a learning assessment done (on our list of things to do as the budget builds back up).

In December last year the psychologist added ADHD.

In January she qualified for an IEP with SLD but nothing specified as to the cause. The school psychologist mentioned low executive function but the numbers I have are generalized. Working memory and processing speed but fall under average though memory was the 68th%tile and processing speed was the 17%tile. With the last two categories at 99% they gave twice exceptional but not that the other exception is. She can't blend sounds, has a speech impediment, has significant trouble copying but can easily discern differences in images, and has trouble recalling number and letters.

Now the OT is wanting her to go to a development optometrist(?) to have her tracking looked at and is mentioning dyspraxia. Dyslexia has always been high on my list due to the severity my mother-in-law has it.

Are some of these likely to be eliminated? Or is this a case where they all overlap so badly they may not be able to tell what is what? And will all of this effect how she learns?

It's really amazing to see how many things she struggles with but had adapted in such away that we didn't suspect a thing. I just wanted to know why my child can't look at me or remember a letter after teaching it for week even though she can name every character on My Little Ponies!

Hi AtSouthDam,

Some of these things could well fall into an umbrella diagnosis. (Autism, for example, often encompasses executive functioning, attention, sensory, and anxiety issues.)

I'd say it is worth finding someone who can do a really detailed neuropsychological workup-- preferably someone who sees a lot of kids with autism and a lot of girls in their regular practice. We found the autism center of a children's hospital the most able. Because you suspect LDs as well, you want to make sure they test thoroughly to tease out what's really going on. I'd expect something like 6 hours of testing and observation, with input from you and from teachers as well.

I think it's important at this stage not to panic. Even if your DD has unusual wiring, she can still have a happy life; there are so many ways to learn to manage. Once you have answers, it will be much clearer how to proceed.

DeeDee

We're on the waiting list for neuropsychological testing at the university this summer but I've gotten so much information these past few months I'm overwhelmed. I wouldn't say I'm panicked, just shocked. And missing my old pediatrician, the new one doesn't even know what a developmental optometrist is or does (Kaiser thing, perhaps?)

And I think you are all amazing as I hide in the shadows and read about how you know what services your child needs to succeed and achieve their potential. I'm not even sure where to start other than giving her a written alphabet in front of her when she writes and a hundreds chart for math.

That is precisely it, though-- you solve one problem at a time, as it comes before you. Gradually you come to understand how. None of us was born knowing any of this stuff...

DeeDee

The more I learn, through school and personal research, the more I think they're all kind of... different versions of the same thing.

For example, HFA seems to be right next to severe, combined type ADHD on a continuum, differing mainly by degree of severity (but being very similar in terms of deficits & characteristics). Then you have something like OCD, where sufferers perseverate on things... but wait... isn't perseveration a spectrum thing? And aren't the OCD perseverations a means of managing anxiety? So... do they have anxiety, or OCD? Or both? Or... (I could go on but you get the idea)

It's like one big house, but with different rooms.

AtSouthDam - I'm in a hurry at the moment so don't have time to write out a well thought out reply, but fwiw, my neuropsych sees it a bit the opposite (inverse maybe) of CCN's description of one big house with different rooms - she would tell you there are a few big houses (ASD spectrum, ADHD, Dyspraxia) with some shared types of rooms and some rooms very individualized (think one house has a movie screening room, one house has a workout room, one house has a parlor for the dog... but all the houses have a kitchen, bathroom, and bedroom). It's not easy to tease out what's up with our 2e kids when they are really young, but the answers come with time, with evaluations, and with observations. The other advice our neuropsych gave us was that each specialist who does an evaluation is going to see (or not see) what they are looking for or what they are familiar with - but they aren't necessarily going to see the big picture - that's where having a neurospych evaluation is really *really* helpful, and also where you as the parent also become the expert in your particular child.

A real life example for you - we had no clue our ds had any kind of challenge other than being cute, quirky and amazingly intelligent when he was little. His K/1 teacher thought we were overestimating his abilities because he "sounds so smart when he talks." His 2nd grade teacher was convinced he was low IQ and had ADHD. We were convinced he was going to end up in a psych ward by the end of 2nd grade. That's when a neuropsych diagnosed dyspraxia. A few years later a counselor was convinced we should have him evaluated for ASD, but a follow-up neuropsych ruled out ASD. He also has an expressive language disorder diagnosed by an SLP. I feel confident, today, now that he's in middle school, that we have the correct diagnoses (dyspraxia and expressive language disorder) - but it took quite a few years to figure it all out. In the meantime, we plugged away as DeeDee mentions - one thing at a time, and he's made great progress.

I'll also add that the actual therapies he's had are targeted at specific skills, so at that level, it doesn't always differentially matter is the overall diagnosis dyspraxia or autism or whatever... the therapy needs to target the skill that's a challenge. OTOH, it's extremely helpful to understand the overall diagnosis too - because that helps you put the pieces of the puzzle together in a meaningful way.

Best wishes,

polarbear

As the others have said, it's often very difficult to figure out exactly what's going on... and that's a direct cause of the way 99% of all these issues are diagnoses - observable behavior. I wish it were feasible to do brain scans on these kids to actually figure out what's going on. It's possible your child actually has a seizure disorder and absolutely nothing else wrong. It's possible she just happens to have 10 different problems. You've really got to start with a Neuropsychologist, IMO.

One thing I will say - ADHD shouldn't really be *added* to other mental health diagnoses. One of the essential features of ADHD (as defined by the DSM-IV is "The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better accounted for by another mental disorder." It's often given as a secondary (or tertiary, etc) diagnosis, though, to help people understand what's going on with the child. It's very likely your child doesn't actually have ADHD, but exhibits ADHD symptoms as a result of the other issues going on.

Yes! So how often, when diagnosed, does ADHD actually exist, or is it merely an expression of another underlying issue? This is where you open the "is it real?" can of worms. I think it is, just over-diagnosed.

My advice, for any parent dealing with an ADHD diagnosis, it to acknowledge it for sure, but put it off to the side (take it with a grain of salt) and keep digging.

That's exactly what we've done for now. It's been noted with requests from the OT to incorporate tactics for it but we're not looking at medication until we have a much better idea of what is going on with her.