Gifted Issues Discussion homepage Forums Twice Exceptional Learning disability along with ADHD?

Polarbear, thank you SO much for your thoughtful responses! I really appreciate it.


He gets distracted very easily--for example, I have to tell him repeatedly to do something at home if there is anything else going on that he can see or hear. He has an extremely hard time focusing on things he's not interested in. It takes him much longer to complete homework than it should--even things he's good at like math. When we're at a doctors appointment or something, when the doctor and I have to talk, he has a hard time just reading and not trying to engage with us or saying he's bored. He interrupts constantly, even with repeated instruction to wait to start talking if someone already is.

I know ADHD is misdiagnosed sometimes, and I went back and forth repeatedly in my mind wondering if I should mention it to the doctor. He has taken outside classes of interest to him and not had one bit of trouble.


The only thing the psych (she actually just tested him at almost 9 years old) mentioned was working memory score. She didn't talk about the NEPSY results at all. She used SB5, NEPSY II, BASC-2 (teacher, parent, and self-report), and VABS II.


The psych had that report from the OT, but never mentioned it. In the report, the OT noted that the discrepancy could be causing his trouble with writing, but she never said that to me or offered any deeper thoughts on it (I only received this report when I requested it to give to the psych). None of the evaluations he's had done have included finger tapping. I actually have asked the OT and developmental pediatrician about dysgraphia, but they have dismissed it because his handwriting is pretty age-appropriate and he can copy writing just fine. He had a natural pencil grip as a toddler (starting at around 14 months), but around age 6 or 7 started holding it in his fist. I don't know if this is significant at all.


He actually had an evaluation with a SLP also when he was 7, but she didn't use any formal tests. She diagnosed him with some kind of expressive language disorder based on informal observation, but never gave me any details about this (Again, I actually didn't even know he was technically diagnosed until I got the report to give to the psych recently).

He received speech therapy to work on a dysfluency issue that appeared a few years ago where he started adding lots of "mm" and "uh" between his words, as well as conversation skills. She discharged him from that after a few months, saying the disfluency is probably just his brain working faster than his mouth. He still has it, and other doctors and therapists have disagreed with that explanation but can't offer one of their own.

Unfortunately, at this point he hates writing and has no desire to ever get better. Intellectually he knows that he has to in order to get through school and achieve his goals (become a chemist), but that doesn't stop the negative attitude (which I'm not criticizing him for; I think it's understandable, but must be overcome somehow).

Scribing is limited in that it takes someone's time to do - so it's not a reliable way to accommodate during at school. The most typical accommodation in elementary school for children who have handwriting challenges is keyboarding, either with a Neo or Alphasmart or a laptop or an iPad or other tablet. I would start having him type this summer - you don't need to have him learn touch typing, but let him come up with his own adaptive finger techniques as he learns. My kids all had fun with BBC Mat typing, so it was a good place for us to start them learning typing - other programs will work too, as well as just having him copy lists or send emails to relatives or play games that require typing etc for practice using the keyboard. It may seem like it takes him forever to type, but compare both his output (detail, amount etc) to what he outputs with handwriting as well as the elapsed time - my ds types rather slow, but it is still considerably faster than his handwriting speed.

If the school is willing to let him use an iPad at school, that will be great! My ds uses an iPad and it has quite a bit of utility for children with writing challenges. I wouldn't, however, expect that voice-to-text will come easily at a young age - that may need to wait until he's a little older, it just depends on the child. Even if he wants to try voice-to-text and it works for him, I'd still also start him typing.


I scribed for my ds on homework all the way through elementary school and I still do occasionally now that he's in middle school and comfortable with all of his technology. Even with typing and voice-to-text, there are times when it's simply easier for him to write while talking without dealing with recording it or typing it out. Scribing can't happen at school at this point, but imo it's a-ok at home.


Yes, that's what I was thinking when she said it!


If he was writing sentences etc when he was that young, I doubt he has dysgraphia, but that doesn't mean he doesn't have a challenge with some of the other components that go into the act of handwriting - spelling, punctuation, sentence structure, ordering and organizing words etc. Another test that can be helpful teasing out issues with writing is the TOWL (Test of Written Language) - has he had that? It's typically given by schools or OTs evaluating for learning disabilities related to writing.


It's just referred to as an "expressive language disorder" - nothing more specific. I'll look tomorrow and pull out the report from his SLP to double-check that but that's all that I recall it being listed as. The test the SLP gave that she used to diagnose was the CELP (I think that's the correct acronym!)... he had a large discrepancy between two subtests and two other subtests but all of his scores were above average (the discrepancy was between something like 99th percentile and 61st percentile... again... I'm just going from memory so I may be incorrect!). The diagnosis was based on that split as well as observations of his behavior during testing - there were no time limits on the test, and there was one subtest where he did come up with answers, but sat staring into space most of the time struggling for several minutes to come up with the answer, so the SLP considered that delay in response to be significant.

polarbear

What you've described does sound like ADHD (not that I'm a professional lol!). I have heard that writing difficulties are common among children with ADHD. The one thing that I'd mention is the time it's taking him to do homework - there might be a piece of that that is due to other challenges - my ds spends a *lot* of time on homework every night - I'd guesstimate at least 2-3 times as much as his classmates, and it's not because he doesn't grasp the concepts quickly - it's the act of getting it down on paper. Math is his big homework time-sink, but he grasps the concepts very quickly, he simply takes a long time to write it down and tends to make copy/etc types of mistakes.

If homework is taking a long time and it's only providing him with opportunities for endless repetition rather than helping introduce new concepts, you can add an accommodation for reduced homework or extended deadlines - my ds' math teacher lets him choose one of each type of problem to do each night and doesn't require him to do more if he doesn't have the time.



There are three subtests on the NEPSY that test "finger tapping" (and repeating hand signals) - difficulties on this test point to fine motor coordination issues that happen with some kids with dysgraphia. Visual processing challenges can also cause dysgraphia - that's something that should show on the Beery VMI.


There are different types of dysgraphia with different manifestations. I'll try to find a link to a site that describes the differences. One type of dysgraphia involves lots of spelling errors, another doesn't. It's also really tough to "see" dysgraphia in the early elementary years because the reversals/spacing challenges/etc that some students have are also seen in typically developing students. He's old enough now though that I'd expect if he had dysgraphia you'd see signs in comparing his handwriting to his classmates.


This, combined with his challenges with written expression, suggest (to me) that it's most likely worth trying to pursue a new SLP eval.


Do you think the mm and uhs are his way of stalling while he tries to think of what to say? Have you paid attention to see if your ds has more trouble with certain types of speech (the type that correlate with open-ended questions etc, similar to where he struggles with writing?).

pbear

I'm probably biased in this respect since science is my love and career - but fwiw, I absolutely believe he'll be a-ok! Whether or not he ever figures out how to write. One thing that I've found to be really important for my ds is to keep giving him opportunities to follow his passions and areas of strength in spite of having to put in extra work in the area he's challenged in. I also try to keep *his* eye on the long term, and remind him that while he'll need to produce creative writing in high school, once he's in college it's quite likely he'll only have to focus on technical writing, and that really is easier for my ds, and I suspect it will be for your ds too based on what you've written here

Best wishes,

polarbear

Polarbear, I really cannot thank you enough for your wonderful insight.


He has not had this. I think it is important that he does, though. The OTs we've seen haven't seemed very knowledgeable in the area, so I guess we are going to have to request it from the school.


I will definitely get him in for another SLP eval and request that test.


Yes, almost everything he did last year was endless repetition. Aside from writing, he is very academically advanced and requires little repetition to master the material.


Yeah, she only gave him the NEPSY subtests related to diagnosing ADHD, unfortunately. Visual processing is his strong suit, so I don't think there are issues there. I really think he needs to have the TOWL and CELP.


Yes, he does. It seems so strange to me that for years he would hold it correctly without any instruction at all and then all of a sudden start with a different grip. He is also very resistant to doing anything to change it, because it is too hard for him.


It does seem like it. He also takes a long time to come up with what he is going to say.


Oh yes, open-ended questions are much harder for him to answer, just like with writing.


Thank you for writing this. I try really hard to find ways for him to follow his strengths and passions (outside classes/camps mostly).