Gifted Issues Discussion homepage Forums Identification, Testing & Assessment New here - would you question this 2e diagnosis?

Hi - I'm new here and hoping someone who has been there, done that can help.

DS is 8 and has always had behavior concerns -- mostly around not fitting in, being bossy/aggressive and impulsivity. In classrooms he gets bored and becomes the class clown. He also moves a lot when stressed, worried, happy, etc. He was identified gifted early and spent K and 1st in an accelerated program. 2nd grade was mainstreamed into a 2nd grade class when we moved but with a year-ahead math pullout program and differentiated reading. Behavior issues all year long. Things got better but did not get fixed. We did a private neuropsych eval this summer. The neuropsych jumped right to ADHD because his father has ADHD but I've read enough to really worry about misdiagnosis for them both. Here are a few of DS's results:

WISC-IV: FSIQ 130. Verbal 133 and Perceptual Reasoning 136. Working memory 123 and processing speed 91. Tester very much keyed into the discrepancy as positive for ADHD. There are fine motor issues with handwriting, which could explain some of the results.

Tester then did TEA-Ch for attention and the results were scattered all over the place from High Average to Moderately Deficient. Then he used BASC inventories from DH, DS and me. All showed concerns with attention, but DH and I showed lots more concern about impulsivity. All three of us were answering largely about school.

The thing that is troubling me is that I feel like his dad's diagnosis biased the tester toward ADHD. I don't feel like my son is like his father. DS is impulsive and emotionally intense and 100% has trouble with behavior in lecture-type school and in large groups of peers. But he does not show those behaviors at home -- they are situation dependent. I told the tester all of this but it didn't seem to register. He says ADHD explains it. Maybe I'm too used to his father's disease, but my gut is telling me to question this. I think his emotional and social problems are coming from somewhere else.

For those of you who have been there, would you question these results and conclusions?

I can't tell you anything about ADHD, however, I will say my ds has a similar profile: VCI being the highest index (I know yours was the PRI, but both are best indicators of giftedness) and Processing Speed being the lowest, really low, and our tester didn't bring up ADHD at all, but rather, perfectionism issues. I don't know anything about the other test.

Here's a talk given by James Webb if you haven't seen it. I don't know if it will help or make matters muddier...

http://videos.med.wisc.edu/videos/32540

I also want to add that our ds has more emotional intensity at home than at school. I suspect it's more that he trusts us and therefore can let it all out.

I would. Two things jumped out at me. First of all, that seems to be a pretty high Working Memory score for a child with ADHD. I'm not a psychologist so someone may know better than I, but I know that when DS9 was tested his high Working Memory was something our psych used to explain to us why we the behavior we were seeing *wasn't* ADHD. When another gifted friend was tested (who has since been confirmed to have ADHD through extensive testing) her Working Memory score was rock bottom.

Second, you mentioned that when filling out the inventories you all were referring to school situations. We did that too when we filled them out initially and DS came out as likely ADHD. We went to the psych who explained that we needed to refer to the home environment. Part of the DSM criteria for ADHD is that the behaviors are present in more than one environment- so if you are all filling it out based on what you know about his behavior at *school* you are missing the chance to evaluate two environments and are really evaluating only one. After we found that out we filled it out based on what WE saw at HOME and DS no longer met criteria based on the inventories.

As he's aged from 8 to 9, so many of the things that were driving the school crazy have slowly worked themselves out, assuring me that the psych was correct that this was not ADHD and was merely asynchronous behavior and struggles with giftedness in the classroom. I can't speak for your son and whether the diagnosis is correct or not. But I can say that your questioning it seems very reasonable to me.

Google "ADHD overdiagnosis epidemic".

Processing speed also has a written component. Just for better information you may want to get the GAI calculated as that removes the PSI and WMI from the calculation as both of those have poorer correlation with the general intelligence measure.

DSM-V criteria for ADHD http://www.adhdbasics.org/ref/DSM-V.pdf includes:

It strikes me there is a general bias towards the diagnosis.

I'm new here too. Your son sounds similar to mine. My son is 7 and was recently put into our school district's "Highly Gifted Program". He hasn't started it yet, but it sounds like it offers after school social groups, which he needs.

My son scored 97 on the Processing Speed and 110 on Working Memory, which is quite a bit below his other scores.

My son's main problem is that he is very high strung, he has a hard time making friends. He over reacts to things like stubbing his toe... you would think his toe had been cut off. He does not like to write at all. He is overly sensitive to smells. We are taking him for an OT evaluation next week.

I have been really worried about my son since he was a toddler. I'm afraid he has a hard life ahead of him. He is also a very negative thinker, one of his bigger issues.

Thank you all so very much. You've helped give me some great follow up questions, other points to consider, terrific tips and just generally let me know I'm not just deep in denial here. I'm going to find someone who specializes in gifted to get a second opinion and we're already moving forward with OT. The overdiagnosis issue is exactly why I'm really struggling with this. The test parameters that the psych is pointing to are the outliers or are all referring to one situation -- in groups of peers. I feel like they can be explained by other issues like fine motor deficit and boredom just as easily as ADHD (there was a tester-described "very boring" inattention test done on computer during the end of a 5 hour test day -- I would have scored badly on it). DH is definitely ADHD and I see all the signs and symptoms. With DS I just don't see the inattention. He is "here" where his Dad is much more off in his own world, is disorganized, irresponsible, etc. All the behavioral stuff could also be overexcitabilities or sensory issues and so I'm just confused and uncomfortable. I can see why ADHD fits but I can also strongly see why not. I know there are multiple presentations of ADHD, but I also know that gifted boys who are young for their grades are at super high risk of misdiagnosis. Ugh -- this is just hard.

Thanks again so much to everyone. Not sure what everyone did before there were resources like this. Thank you, thank you, thank you.

I would certainly question it... one of the key factors in an ADHD diagnosis should be "do the behaviors exist in ALL environments?" If the answer is no, I would seriously doubt the diagnosis. Now, obviously, you don't really see ADHD symptoms when they are doing things they love, but, in general you'll see problems at home, at school, and in recreational situations like soccer practise.

Also, my son, who has ADHD, had scores like so:

VCI = 100
PRI = 145
WMI = 107
PSI = 109

The VCI is likely a result of his PDD-NOS, but the low working memory and processing are a combination of ADHD & anxiety.

You should always question any diagnosis that contradicts your gut. You can continue to pursue a second medical opinion and time as well may clarify the issues.

However, I also want to point out that the working memory score does not preclude ADHD. While it is true that one typcial profile for ADHD is low working memory, it is not a prerequisite. My DS who was diagnosed with ADHD also had a similar working memory score. Another point to consider is that if the recommended treatments help the behavior, then it may not matter even if your DS does not really have ADHD.

If the impulsive/inattentive behaviors are never observed anywhere else but at school, then I am inclined to question the diagnosis. However, keep in mind that you may have created a home environment to cater to his deficiencies and that your tolerance level is far higher than a non-family member. For example, it is easy for ADHD children to focus on what they want to do, be it legos, puzzles, computer, fun books, etc. The test is paying attention appropriate to an environment when you don't want to do so.

I think you need to consider the possibility that he doesn't appear to have problems at home because you are exceptionally good at managing and preventing issues. Grinity, who doesn't post much anymore, mentioned more than once that you should never underestimate the ability of a gifted parent (mother) to compensate for their 2e child and make them look "normal" at least some of the time.

I know too many kids wih ASD or ADHD who either behave impecibly in the world and then fall apart at home, or are ok at home but not at school to have faith in the "multiple environments" thing. Sure if he's fine with all teachers except one then its probably the teacher.

Also it's common for kids with ADHD to have either (or both) WMI and PSI low, but neither are a requirement. My DD has ADHD and has WMI in the HG range! And yes she absolutely has ADHD and you can see that the WMI is high in every day life. Possibly her processing speed is low but it's never been tested accurately.

Also ADHD is far more heritable than asthma or breast cancer. If the tester WAS biased its not without reason there.

By all means get another opinion, but please consider the possibility this is real.