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

Hello, First off, I'm sorry for posting here because my son's FSIQ is not even close to Davidson's cutoff, but I really need advice and I've been reading here for a long time. My son recently had a private psychological evaluation because I suspected ADHD along with being gifted. The testing confirmed both these (although FSIQ was quite a bit lower than I would have guessed).

He has huge issues with writing--not so much handwriting, but coming up with what to write. So far the testing psychologist along with a developmental pediatrician have said that it's probably because of the ADHD. However, I was wondering if it could be a learning disability. Last year (before this psych evaluation) I asked the school about evaluating him but they really didn't want to and basically said "we legally have to if you request it, but let's try these informal accommodations first". The informal accommodations worked sometimes, but not always, and they weren't consistent in implementing them. On his last two report cards he got "at grade level" for writing, only because the teacher sent the graded papers (they don't all count for a grade) home and I sat with him for hours pulling every single word out of him.

I was hoping I could post my son's test scores and maybe somebody would have some kind of advice. Also, could anyone give me any ideas of how schools can accommodate for weaknesses while also challenging him? He has been identified for the TAG program, but he was only tested in math and it's up to each teacher to differentiate for it. They seem pretty reluctant to give him more advanced work in anything else because of his writing problems.

Last year at age 7 he had an OT evaluation where he was given the Beery VMI and his results were (score, percentile):
Visual Perception 142, 99.4
Visual Motor Integration 99, 47
Motor Coordination 97, 42

The most recent testing at age 8 included the SB5 and several subtests from NEPSY II.

SB5 results:
Fluid Reasoning 138
Knowledge 117
Quantitative Reasoning 133
Visual Spatial Processing 137
Working Memory 106
FSIQ 130

NEPSY II:
Animal sort total 17
List memory 10
Auditory attention total 11
Auditory attention combined 10
Response set total 10
Response set combined 6
Word list repetition 12

Word generation semantic 5
Word generation letter 11
Inhibition naming combined 12
Inhibition inhibit combined 15
Inhibition Switch combined 16
Clocks 14
Word list recall 16

I'm so sorry this is very long. Thank you if you read this far.

Don't apologize for posting here - your son is clearly twice exceptional. It's very unique struggle and the people here are wonderfully helpful and supportive. I can't give you specific help with the scores and I can't remember my sons off the top of my head; but, what I do have off the top of my head was the similarity with your son's fluid reasoning and working memory - my son has a similar gap - high fluid reasoning, low working memory ... In fact, my son's working memory score was exactly 106 like your son's scores. He had many of the other tests, too and I'd have to get his tests out to compare. I can tell you my son has Ehlers Danolos (and, so, he has physical limitations for writing because of his joints and poor muscle tone) and it is strongly suspected at this point that he has developmental coordination disorder and dysgraphia (my understanding is that dysgraphia almost always accompanies DCD and the DCD is very often co-morbis (caused by?) the Ehlers Danlos). I am taking him to eval'ed for the DCD and Dysgraphia formally by a neurpsych. There is suspicion that he has adhd inattententive but even though it LOOKS like he may have that I really think it's just the dysgraphia and DCD looking like adhd. Anyway hopefully someone else can help you more and welcome!

I can also tell you that my son has no problem coming up with what to write - he's totally a writer that way... but physically writing by hand is very hard on him and his Berry scores were exceedingly low,, hence the dysgraphia suspicion. Seems like your son has the opposite problem. I think that is usually called "disorder of written expression"

I'm not a diagnostician... but it seems like an incomplete picture of things. Tossing the details together, it reads more of a narrow challenge area.

Is he able to tell stories? Recount things that happened to him with semantic details? Does he build things or do art with original content? Is he a bit of or even extremely perfectionistic? Does he take a long time to make decisions when things are of similar value to him?

I noticed the difference between word generation semantic and letter. He may just have too much going on in his head and needs help narrowing down his thinking. One of the cooler concepts/tools out there for creating creativity constraints or ideas to spring from (works either end of creative blocking issue) is having a set of pictures to work from... such as these from IDEO:
http://www.amazon.com/IDEO-Method-Cards-Inspire-Design/dp/0954413210

When stuck, you randomly grab a card, e.g. it's a steering wheel. Then ask yourself "How can I write this/answer the question in a way the makes me think of steering wheel?" or such.

Thank you for responding. He never really tells stories. He can recount things that happen very well verbally. His teacher last year commented on how it was frustrating for her because he was so eloquent when she talked to him, yet you would never know it by reading his papers. He does build and do art with original content sometimes, he especially loves coming up with intricately drawn paper and pencil games, although he does go for long periods where he doesn't because he can't think of anything.

I've never thought of him as a perfectionist, because he doesn't necessarily care if something he's doing or making turns out perfectly or not. However, he has always been very hesitant or just refused to try new things he wasn't sure he could do well. He also hates putting a lot of effort into things when they don't come easily. He does have a very hard time with decisions.

Even when he has a topic to write about, he has such a hard time coming up with anything. He went for many writing periods last year (grade 3) not getting a single sentence down on paper.

Thanks again for your response.

sciencelover, please don't worry about posting here - you are most absolutely welcome to post!


Can you tell us what made you suspect ADHD? There are a few of us here who's children have been incorrectly diagnosed with ADHD when it was actually an LD (or something else) that was the true challenge. I'm not suggesting your ds doesn't have ADHD, just curious about the reasons you suspected it. There can be quite an overlap in symptoms between different diagnoses.



I am not familiar enough with the SB to comment on the scores, but fwiw, I suspect that if your ds had been administered the WISC, he would have received a GAI calculation that was higher than his FSIQ. The GAI on the WISC removes the processing speed and working memory subtests, and it appears that working memory was a significant dip in scores for your ds. I'm not sure how processing speed impacts any of the SB scores - but you'd see the impact in timed tests.

I'd also add that an FSIQ of 130 is a high FSIQ


My ds13 is dysgraphic and also has an expressive language disorder that impacts writing. He had a diagnosis of "Disorder of Written Expression" when he was first diagnosed with dysgraphia in 2nd grade. We didn't realize until he was around 9-10 years old and his dysgraphia had been accommodated that he was also struggling to get thoughts out. The first signs of this were in classroom writing assignments - he often had no idea of what to come up with to write about. Open-ended assignments are the most challenging for him.


My personal advice would be to get a private SLP eval. You can request the eval from the school, but it's been my experience that we have received much more thorough advice and information through private evals. In our case, our ds would never have qualified for school district SLP therapy either, because ther is a very specific set of bars which must be met to qualify, and they include speech issues which he doesn't have. His scores were on the speech eval were also too high to qualify across the board, yet they absolutely showed large discrepancies in ability and revealed the expressive language challenge. He's been working with a private SLP for 2+ years now, and it is absolutely the single best thing we've ever done for him with re to writing.



Can you look at any of his past writing and see which types of assignments he was successful at and which were really difficult? I wonder if the inconsistencies you saw were related to getting help or if they might have been related to the type of writing assignment. Some things are absolutely easier for our ds to write about - things that are factual or things he's observed.


This was always a challenge for us in our ds' original school. It's also very teacher-dependent. It's one reason that getting an evaluation and either a 504 plan or an IEP is *very* helpful for 2e students (or any student with a challenge) - it gives you a formal document outlining what support needs to be provided, and when it's not provided, you point out to the teacher/school staff/etc that it's required.

That said, I've also found that parenting a 2e child through school requires a lot of extra attention on my part, keeping up with what's happening, and supporting my ds with extra help/tutoring/etc outside of school. The help that the school could and would give wasn't enough to really help him in the way he needed it.


I'd suggest you need to do two things - one is to seek outside testing, but the other is to put in a formal request for an evaluation through the school. You need to let them know the type of support and how often/much you are providing at home - it should most definitely be included in the evaluation.

The other thing you wrote sounds so familiar - "pulling every single word out of him". This is not typical. It's a sign of a challenge, and it sounds soooo so very much like my ds.


The first step toward this is to really understand what's going on with his writing challenge, hence I'd seek out the additional testing through an SLP. I'd also wonder if what you're seeing is ADHD or something else that looks like ADHD, and I think that's important to tease out before you can come up with a good accommodation plan. What did the psych who did the testing at 7 years old say about the NEPSY results? What did he/she have to say about the ADHD diagnosis - what testing/behavior surveys/etc was taken into consideration to come up with it?

Likewise, it's really important to have him placed appropriately for his intellectual level - even if he's struggling with writing. When my ds has been successful with writing at school, he is *very very* good, and it's clear that he needs to be writing at his intellectual level, not at a lower level. My ds also became very discouraged in elementary school because the pace of classroom discussions and work was below what he was capable of, but the school wouldn't advance him because of his writing challenge.


That's a really large discrepancy in scores - did the psych have an explanation for it? You see discrepancies like this in kids with dysgraphia - have you seen any potential dysgraphic symptoms? Did your ds' NEPSY tests (or other psych tests) include anything called "finger tapping"?

Your ds also had a low score (not just relatively low) on "word generation semantic" on the NEPSY - this is the type of skill my ds had a lot of difficulty with when he was first diagnosed with an expressive language disorder.

Sorry this was such a long reply - I hope some of it helps!

Please feel free to ask us more questions

Best wishes,

polarbear

I'd only read your OP when I responded, and just now saw this too. So here are a few more rambling thoughts from me


This sounds very much like my ds. My ds also didn't do the type of creative/imaginary play my dds did when they were young - he spent most of his time building things or reading or observing.

Look at your ds' writing assignments at school - chances are that he's being asked to write things he hasn't directly experienced - which is much different than recounting things that have happened.

OTOH, a large difference in what a student will be able to descrive verbally vs on paper is also an indication of potential dysgraphia - in that instance, you can see a difference with the same *type* of writing request. But comparing a writing assignment on paper that is something like "write a story about an apple" vs telling verbally "what did you see happen in the science experiment" are two different types of expressive language skills, so the difference isn't necessarily pen-to-paper vs verbal, it's more likely in knowing how to deal with the open-ended assignment, which is where my ds' challenge is.


I just have to add a snide comment here (directed at the teachers remark, and and please know, I'm not a snide rude person, this just hits a very tender spot in my heart!) - yes, I'm sure it was frustrating for his teacher - but imagine how much more frustrating it was for *him*!


Again, this sounds very *very* similar to my ds. It's probably worth mentioning here that drawing is a very different skill than handwriting, fwiw.


Difficulty putting thoughts onto paper can *look* like perfectionism, and it's easy to think that there is perfectionism present due to gifted abilities - perfectionism is listed as a trait of highly gifted kids so often it's an easy thing to reason is going on. We thought perfectionism was the difficulty our ds was having when he first started struggling in school, and how I wish we could go back and realize sooner that it wasn't that at all!


This is a typical thing (imo) for children who have some type of challenge. H'es experienced situations where he just *can't* do something, and it feels either frustrating or discouraging or whatever, so in turn he's hesitant to try other things that are new. We saw this in our ds a lot when he was in elementary school and we were working through getting accommodations in place and helping him with his challenges and trying to understand everything that was going on. Once we understood his challenges, had his accommodtions in place, and he'd had the experience of both understanding why things were hard for him and also experienced some successes with his writing - the hesitancy to try other new things disappeared. That took quite a few years though!


He's still very young. Quite a few of us adults don't enjoy doing things that don't come easily. Re the difficult time with decisions, my ds experiences this too. I think part of it is just being human, part of it is related to his challenges with expressive language, and part of it is a tiny bit of worries due to having experienced challenges in his life - ie, he has lack of confidence that he'll be able to do whatever it is successfully so can't make up his mind. Or predicts that whatever decision he makes will lead to something not working out - which had been his experience in school when he was younger. This too has gotten much better as he's matured and we've been able to understand and accommodate for his challenges.


TOTALLY completely sounds like my ds.

polarbear

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.

Sounds like it lines up quite well with Polarbear's experience.

The nice thing about bright people is they often have an innate aptitude for taking control of their own meta-cognitive development. For a kid it may just take a little prompting to get them thinking about building their own toolkit of tricks and skills to get past their stuckednesses.

I'd definitely suggest a picture prompting approach as one element. You can make a set of a dozen or so pictures from magazines pasted on index cards. Another creativity skill that can help bridge from the analytical thinker in to more creative approaches is an oddly mechanical approach: create categories and sub-category structures then mentally step through those until something clicks.

There can also be blocks when someone isn't sure that they understand the system they are supposed to be working on (e.g. what are correct ways to make a story.) Theoretical reading on plot structure (e.g. the 7 basic plots), narrative pace may all seem to be high schoolish in knowledge content, but may be the sort of content keys a bright kid needs before they are comfortable diving into such a nebulous ill-defined domain as creative writing.

A final element for the moment is that having any sort of randomized input (e.g. I've used the milliseconds digit on a watch/stopwatch) can distance him from the weight/responsibility of making a first decision before writing. "I will write about either 1-3: Monkeys, 4-6: Cars, 7-10: Robots."

There are lots of techniques, I don't know what OTs do or suggest.

It actually seems like he has both issues. If you asked him to tell a story about an apple, he probably would not be able to do it verbally or on paper. Also, I did notice in his assignments that open-ended ones were much more difficult. He does have a much easier time when he can do an assignment verbally, though. His teacher sometimes scribed for him, which worked out pretty well, but she couldn't do it consistently. They said they were going to let him use speech to text on an Ipad but that never happened. Also, he had to bring his reading group questions home frequently because he didn't get them done in class--when I scribed for him I noticed that his answers were WAY better than when he had to come up with them and write them at the same time.


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


This is interesting. My son has been like this since he was a toddler, and back then it didn't look like he had any challenges at all, except that he was very physically timid. He started writing letters and numbers before he was two and sentences before three.

Again, thank you very much for responding. It has been very very helpful. Do you mind if I ask if there is a name for the specific expressive language disorder your son has? Also, should I ask a SLP to perform certain tests in an evaluation?

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).