Gifted Issues Discussion homepage Forums Twice Exceptional ADD/EF: where would you put your money?

We haven't had dd evaluated in quite a few years, but she has over the years had IQ testing, achievement testing, counseling, and other evals. Her dx include inattentive type ADHD, anxiety (which may not be a severe as it was at the time of the dx), and possible dyslexia. She is also HG+ per IQ.

In elementary, it was hard to get any recognition for either the giftedness or the LDs b/c she wasn't the consistent high achiever who performed well on group tests, loved reading, hand in the air, etc. In middle school, they recognize the giftedness, but tend to attribute the problems like not turning in work, erratic performance, inability to remember things but high conceptual understanding, etc. to pre-teen development and just assume that she'll outgrow them and aren't seeing the LD. As a result, we've had huge lack of follow through from teachers on doing what they agree to do to support her LDs b/c they don't all seem to believe there is a problem (save for her English teacher last year who also had a HG 2e kid).

So, we're at the point of one of the following:

- moving her into easier classes against the strong opposition of her teachers so the work is too easy and the processing/executive function issues aren't a problem b/c she isn't, technically, needing to "process" much;
- trying "educational therapy" with the realization that we cannot afford to do as much as would be recommended ($75/hr for a few hours/week for 3 months-a year is the recommendation; we'd, at best, be able to do one hour/week for six weeks or so and then try to continue at home with the same techniques). Here's the therapy we're considering: http://www.rockymountaineducationaltherapy.com/services/educationalTherapyTreatmentPrograms.php
- the school principal's suggestion is that we have her see a local psych he's seen do good work with ADD kids and have him review prior testing, maybe do more, and have him write up something for the school on what she needs. He then suggests that we get her on the case load of the RtI coordinator in the fall so there is more follow through.

Of course, we could still do the RtI coordinator if we go the route of the educational "therapist" rather than the psych. Either one, we'd be paying out of pocket.

The hesitancy I have with going the psych route is that dd has seen two psychs in the past and totally clams up and becomes very quiet with psychs. She tends to feel like she is being condescended to and "fixed." She is also very opposed to medicating ADD, which the principal was careful to say he wasn't pushing, but I also got the impression that the psych he was mentioning might be inclined to want to medicate.

Of course, dd may be just as uncooperative with the educational therapist. Dd is also not highly motivated. She wants to do well, but she isn't driven to figure out a way to do so. She tends to refuse any offers of assistance and proclaims helplessness/complete lack of understanding on why she didn't do well on things when she does not.

My concern is not her grades, which are fairly good, but more her processing. She is given opportunities to redo things on which she's done poorly (I'm not sure this is a good idea, but that's a side point...), but she does just as poorly when she redoes things. She tells me that her mind is like a sieve - she just cannot remember things. What her teachers are seeing, and why they are pushing to keep moving her forward in accelerated classes, is that she really gets the concepts and can actually help others who do not and explains things such that it appears that she understands what she is talking about.

We really cannot afford to just throw money in many directions, but I'm not sure where to go at this point. Has anyone had any luck with executive functioning training or anything of that sort? Or, do you think going one of the other routes makes more sense?

What kinds of scaffolding efforts have you tried up until now?

Does your DD see this as a problem? (Not arguing that it isn't, by any means-- just trying to gauge how cooperative she'd be with homegrown DIY based efforts to hothouse EF for her.)

While we don't think there is much beyond asynchrony behind DD's occasional problems with EF demand and her ability to meet it, we've still had to do a lot of scaffolding for her in order to help her with organization and time-management, as well as just, well, keeping a written record of important things, so that she doesn't "lose" them irretrievably all the time.

Our kids sound so alike, except that mine is less gifted and a little younger. She's also VERY hard to help. She clearly has issues, multiple of them, which together add up to quite a major deficit, but none of them are strong enough to be a nice clear problem to attack and get clear results from. Everyone can see that she has social problems and academic problems but no-one can figure out quite how to meaninfully help her. It's frustrating.

The single biggest win we've ever had with her was from buying her an iPod, setting up her morning and afternoon routines in an app called Home Routines (it's designed for managing housework ala flylady) and rewarding her for successful use of said device with the currency of the day (pocket money, toys, screen time, whatever). This made the biggest difference at the start, when she finally had the miraculous experience of being ready for school on time, under her own steam and a) had a really nice morning because no-one got cross at her and b) had 20 mins to sit in the car with her iPod and play on it. Realising that this was POSSIBLE really changed her mindset about being more together. We still have plenty of crappy days, but two years on she now self manages quite well most mornings without the ipod...

We've also set term long goals with rewards at the end - often 2 or three goals (for example you must do 20 mins good quality piano practice every day, must do 10 mins typing practice per day and must include me in the process of planning and executing your term project at school so we can work on those skills and make sure you get it done well and in time). This approach resulted in an embarassment of Monster High dolls, but did definitely improve commitment to piano practice, how she went on her term project, etc. And I found some things (like the piano practice) did not need to keep being a rewarded goal but did keep going at that level after so long of it being normal.

How recent is your latest eval? It might be good to get someone to re-evaluate thoroughly, to know what the biggest measurable obstacle is.


Is there a 504 in place? Was the dyslexia remediated?


For me, that would be kind of last-ditch. What is the work output like?


There's someone around here who does that kind of work, and the families that use that person are thrilled. I have no direct experience with it.

This sort of therapy, esp. for a teen, absolutely requires buy-in. Sometimes the therapist can create buy-in, sometimes not. You also would need them to not talk down to her; she will not be their typical client. I would say, meet with the therapist first to pre-screen. And talk to other people who have used that therapist.

I will also note that our school district has sometimes *paid* for this kind of service. That could be worth looking into.


The RtI part seems really important. Where we have gotten our mileage is having a school special ed teacher on the case to teach DS about organizational skills. He has come a long way because they are paying close attention to instructing him on this.



This is psychologist or psychiatrist? A psychologist should not be working on meds.

Any kind of talk therapy will depend on buy-in. I think an eduational therapist may be a better bet at achieving buy-in because they are more inclined to treat EF as a logistics issue rather than being "broken." But that is just a hunch.


That, to me, says intervention is a good idea. This sort of thing is not well tolerated in workplaces.

I would also talk to the ed therapist about your DD's reluctance to medicate for the ADHD-i. Would your DD revisit this issue if it were presented after working a while with someone she learns to trust, who is on her side? Some people with ADHD really do find that meds are needed.

DeeDee

HowlerKarma, can you elaborate more on the scaffolding you have done for her ? I am looking for ideas for my 5 year old child. Yes, he is 5. And he is usually OK at home, but school has been saying he is not focused (and things of that nature). I could use some EF ideas for little kids


This is very good. Dee dee, do schools, in general, provide this ? Do you have to ask for this ?

We've cobbled together a scaffolding plan that revolves around weaknesses (of both us as parents and her as a child), and our relative strengths. The first thing that we did was to honestly evaluate DD from our individual perspectives as parents. Yes, we love her dearly, and yes, we're non-objective (I suppose), but we also SEE her in all different kinds of settings because of her virtual schooling arrangement, and we're both physical scientists, able to don that "objectivity/criticality" hat when needed. This also gives us additional flexibility in meeting executive demands.

One book that we found helpful as we started was Late, Lost and Unprepared, and another was Smart But Scattered-- the latter was actually the pivotal bit for us, since it allowed us to frame what we were seeing as a two-way thing with parental strengths/weaknesses as well. We also used an organizing-oriented book that has worked MIRACLES for her-- Donna Goldberg's The Organized Student.

We had to get buy-in from her that she was tired of-- a) other people assuming she isn't reliable/responsible, and b) BEING unreliable/irresponsible. Then we laid out ways to help her, and let her help determine what she thought would/wouldn't work and discussed how to tackle the problems that we saw.

Furthermore, this is a sloooooow process. She's light years better than she was three years ago when we started in earnest, but when she improves in one area (she's now VERY good about filing her school papers and putting extracurricular materials where they belong), we work on others.

Routine-routine-routine. For kids with time-management issues, have a routine that is virtually unbreakable. Put exercise into that routine somewhere. Teach very specific attack strategies and remind the child to use them-- think of yourself as a stage prompter until they have the lines down pat.

Basically it is exactly the kind of thing that DeeDee is referring to in her SpEd specialist's approach, but adapted for a tween/teen. I'm not sure how much of that is appropriate for a 5yo.

HK: We bought that Smart but Scattered book (probably on your recommendation because I saw it here first, so thank you!). Looking forward to digging in.

The major thing on dd's end is that she really isn't someone who is late or clearly disorganized. What she is is erratic in performance and she doesn't seem to learn from her mistakes. There is a chart of EF issues on the educational therapist's site here: http://www.rockymountaineducationaltherapy.com/files/pdf/ExecutiveFunction.pdf The first one, working memory, is where her problems primarily lie except that I can't say that she's one who I'd see as being late for appointments. I, of course, am more responsible for getting us places on time than she is, but she is always ready in time for school and appointments and is not one who is holding us up.

I do worry that the educational therapist isn't as familiar with HG+ kids as she portrays. Everyone always says that, yes, I've worked with lots of HG kids, but most people, I've found, haven't worked with kids at the LOG of mine. Wow, that sounds arrogant! I didn't mean it that way, but we have run into problems with various assessors and counselors who really didn't have much experience working with more than high achievers or mildly gifted kids yet who assured us they did.

To answer some of the questions:

No, there has been no dyslexia remediation. It isn't a definite dx, but I suspect that the suggestion is correct. Dh has the same problems and both of them say that reading hurts and do not enjoy it. We've not found a way to remediate as most of the remediation techniques we've seen tend to focus on phonics. Dd always tested advanced on phonemic assessments such as DIBELS and reads above grade level and has for a long time despite never reading if she doesn't have to. Her two WISC-IV tests years ago (one year apart) both had two of the three VCI scores at the ceiling and the VCI as a whole above the 99th percentile. She compensates well and the dyslexia approaches I've seen don't seem appropriate for her. Her issues include words moving on the page, lost place on the page, headaches when reading, and, when she was younger, constantly mixing up simple words like "for" instead of "from" while reading challenging words correctly. We have had her eyes checked multiple times, the most recently a few months ago by a developmental optometrist. There are no convergence or other eye problems.

In terms of scaffolding we've tried: in 5th grade, we tried extended time on tests, testing in a separate room to remove distractions, and a few things like chewing gum in class and taking omega-3 and magnesium supplements. The supplements seemed to work, but she refused to take them by the end of 5th b/c she felt that we were saying that something was wrong with her and we were trying to fix her with pills. The extended time and different room for testing did nothing.

This year I also sat down with her and showed her how to make very detailed, step by step notes and made them for her for one test. She did very well on that test, but her notes using my formatting were not as good later on I suspect. She refused to let me see them or to see what she had done poorly on. She is rather secretive, which makes this harder.

The psych that the principal suggested is not a psychiatrist. However, the principal mentioned a few times that this guy can work with your dr on meds although he followed that up to assure me that he cannot recommend that I medicate my dd. We've been hesitant to go the meds route for a few reasons:
-dd's strong desire not to
-worries about the impact on a growing brain
-having heard that meds work less well for ADHD-i than the hyperactive variant
-worries about reduction in appetite b/c dd is maybe in the 5th percentile of size (height and weight). She'll be 13 in four months and weighs 69 or 70 lbs and is about 4'8" or 4'9". Granted, her size is not atypical in our family, but we don't want to stunt her growth.

Cricket, I agree with the suggestion to have a reevaluation done. Perhaps the school will do it? This way, if you are made aware of any changes, improvements, etc, than you can better target your resources.

Cricket, does your DD give an explanation for her not improving on redo?