Gifted Issues Discussion homepage Forums Twice Exceptional G with processing issues and ?LD

My DS is G with processing issues, but no apparent learning difficulty. However, he recently began high school and has been having problems that make me wonder whether he has an undiagnosed LD. I don't think he has ADHD. These problems may have become more noticeable with the extra organisational demands of high school.

DS received the following WISC-IV scores and was 12 years when he took the test.

I. VCI 153
Similarities 18
Vocabulary 19
Comprehension 19

II. PRI 117
Block Design 10
Picture Concepts 12
Matrix Reasoning 13

III. WMI 135
Digit Span 17
Letter-Number 15

IV. PSI 109
Coding 11
Symbol Search 12

He hit ceilings on 13 out of 18 subtests, in WISC, WIAT and other areas, some of which have not been given percentile scores. Neither a full scale score nor a GAI were provided, as they would have been misleading.

His brother is GLD (dysgraphia). DS had birth distress and was small for dates.

As a toddler he had many ear infections and grommets. He was bothered by loud noises and music. He still has poor singing and music skills. Sometimes he complains of not being able to hear, yet nothing has shown up on hearing tests, which makes me wonder about fluctuating hearing loss.

When he began school he had mechanical problems with handwriting, which affected his self esteem. His writing is still poor (and relatively slow), but he is not thought to be dysgraphic. His fine motor skills are also poor: he was 11 before he could tie his shoelaces. However, his gross motor skills and coordination are generally good.

At primary school he gained high marks in all subjects, but he did have issues with certain aspects of maths, especially those involving basic facts, space and measurement. At high school he is still gaining high marks, although he is having problems with instructions, accuracy and general organisation, which have undermined some of his results.

In many circumstances he thinks and acts very quickly, but not all, because it took him twice as long as it should have done to do some of the cognitive test. Most of the time his memory is impressive, but he has been forgetful recently, and he complains of having short term memory loss. It is extremely difficult to get him to organise himself.

Although DS scored very highly on Listening Skills in WISC-IV, he gained a low score for listening in class. He is slow at making transitions. He often has to get teacher to repeat instructions or he has to ask his neighbour. DS can certainly concentrate when interested, but he often has trouble staying on task.

He achieves highly in reading, spelling, and oral language and is an excellent writer, although his work riddled with *careless* errors.

The school has acknowledged that there is a statistically significant difference between his high verbal and average processing scores and it is allowing him to use a computer in the classroom or have extra time for tests. But I wonder whether there is an undiagnosed problem at play.

Any insights would be much appreciated!

The listening skills issues in class and the repeating of instructions make me wonder how well your son hears in noisy environments. My son had multiple ear infections when he was a toddler and pre-schooler, and has been diagnosed with an auditory processing disorder, dyslexia and mild ADD. He has big problems understanding accents, hearing in noisy environments and remembering multi-step instructions. He can organize a paper pretty well as long as he understands what is needed.

My son benefits from receiving extra time on tests and gets written notes for some high school classes. He used to use an FM system to help isolate what the teacher is saying from the ambient noise. His gifted classrooms were usually pretty noisy.

Another really helpful accommodation is a website with high school assignments, due dates, and a list of what is missing or has been turned in. I wish all the teachers would use this system, but many do not.

Dear Portia and DMA,

Thank you for your helpful suggestions.

Portia, I hadn't thought of a visual problem, but DS does have weaknesses in that area. I'll have to look into what vision therapy entails.

DMA, my DS insists that he can hear in noisy environment and that he only has trouble hearing sometimes. But I do think he may be having trouble following multi-step instructions. What I am not sure about is whether this is due to an undiagnosed learning difficulty or to being an impatient gifted kid.

What I would love to know is how one draws a distinction between "processing issues" and a LD. I have a son with dysgraphia, who, in the past, has had far worse problems than DS, but, when I look at DS's behaviour now he is at high school, they seem to be converging.

Your responses are much appreciated.

Shell

Shell, I am sorry we didn't notice this when you first posted!

I am in a hurry at the moment so not much time to give you a thoughtful reply, but fwiw, what you've described above sounds very much like my ds13 who does have a dysgraphia diagnosis - but his dysgraphia is a result of Developmental Coordination Disorder, which if you haven't looked into you might want to google for a list of symptoms. Note that there is a *wide* range of how this impacts adults and children, so you'll find a long list of symptoms and might come away thinking *NO WAY* does that apply to my child... but fwiw it caught us totally by surprise when ds was diagnosed! Anyway, the handwriting challenges, difficulty with some fine motor tasks like learning to tye shoelaces late, and challenges with organization are all part of DCD.



This also sounds a lot like my ds, except for the short term memory loss.


While this can sound like an attention challenge, I've also seen this with my children who have learning challenges - related to the learning challenge, not a true attention challenge.


Again, that sounds potentially like dysgraphia! You've noted he has slow handwriting speed - do you remember why dysgraphia was ruled out? Did he undergo any tests to determine why his coding speed and symbol search scores were relatively low compared to his VCI subtests? One typical test that neuropsychs give is called the Beery VMI - it assesses visual and fine motor coordination (dysgraphia can result from a challenge with either). Another test for fine motor involves "finger tapping". It might be useful to you to google "dysgraphia symptoms" and look for a list that outlines the different "types" of dysgraphia - in some legibility is impacted more, in others spelling impacted more etc.

I've got to run but have a few more thoughts to share later when I have time -

Best wishes,

polarbear

Dear Portia and Polar Bear,

Thank you for your responses. I've been doing a bit of homework and I think I should investigate both your suggestions.

Portia, the visual processing issue does sound possible, although I'm not sure of the testing facilities where I live.

Polar Bear, when I look at information about dysgraphia, DS11 (the one who was diagnosed with dysgraphia) checks nearly every box. Only a few aspects of most lists fit DS14, except for the following:

silverware x
buttons and zips x
shoelaces x
writing x
colouring in x
connecting the dots x
lego
strong verbal skills x

The 'Xs' indicate those characteristics that apply. DS14 wasn't thought to have dysgraphia because he did not spell bizarrely, reverse letters, or use odd spacing and capitalization. His problem when he first began to write by hand was that his letters could hardly get off the line. They looked like unravelling hieroglypics and were almost illegible. He was also a laborious writer and he complained about having a sore hand. He still does, on occasion.

I have been looking for a list of features that must be present when diagnosing dysgraphia, but I haven't been able to find it. I think there were 3-5 features on the list, including hyperflexion and a tight grip. It would be good if someone could locate that list. Once again, DS11 displayed all those characteristics.

It's interesting that dysgraphia can be a result of DCD. DS11 was diagnosed with dyspraxia as well and received some treatment for it. His gross motor skills have also improved with swimming and piano playing. Nothing was mentioned regarding DS14 and dyspraxia. I'll see if I can track down the Beery VMI and finger tapping tests for both of them.

Thanks to both of you for your very helpful suggestions.

Shell

Auditory Processing Disorder (APD) doesn't mean the person "can't hear", i.e. is deaf. It's the same as saying a person who wears glasses/contacts to correct vision "can't see". I need glasses to read (darn!) and also am required by law to wear them to drive a car. My son uses an FM system at school (yes, even in his 4 person class) to focus on what the teacher is saying (so he can hear.) People with APD often have extremely sensitive hearing, but have problem with discrimination. For example, the teacher's voice is equal to the little pencil scratches across paper, foot tapping, chair squeaks of other kids in the room. Even when a teacher projects very well, the kids are well-behaved, and the student is sitting in the first row. You can imagine how difficult group labs in science room setting are for a kid with APD or a class where kids talk out of turn frequently. And those lovely overhead scattered speakers in the ceiling (which are all the rage for class control and helping everyone hear) make hearing for the APD student much more difficult. If your ds has to ask for directions to be repeated, or check with neighbor to find out what was said, then it really is time to see a specialist in auditory processing disorders (which can be somewhat hard to locate.) You might check out http://www.beyondtheearlouisville.com/ for information on APD. Beware of "screening" style exams that average scores and tell you "yes, there might be a problem" (been there done that, what a waste of time/$$.) Beware of hearing aid stores that say they can help you. Look for an audiologist with specialized training (possibly on a university staff) who is not trying to sell you equipment, and/or check with a local speech/hearing/deaf preschool/school for referral. The FM system (yes, Mom and Dad's funds) has been a wonderful breakthrough for our son. Unfortunately did not purchase it until he was 10.

Dear Gretchen,

Thank you for the very clear explanation of audio processing issues and the tips about what to avoid. I shall look into testing for APD, although I suspect I shall have to travel for such specialised tests.

Shell

I recently had DS14 tested by an OT using Beery VMI. He received the following scores: Fine Motor skills 6%(low); Visual Perception 42%(average); and Visual-Motor Integration 7%(low).

The OT said that if DS14 had to write by hand he would be disadvantaged and she recommended access to a laptop for all work and using photos and voice memos instead of copying from the board by hand. However, she didn't mention dysgraphia.

I'm not sure if these scores are indicative of dysgraphia, or if they are just fine motor skill deficits. During his first year at school, DS14 had great difficulty learning to write and he became demoralised and depressed, but he is confident these days.

From what I can tell, most of the (relatively) low scores DS14 gained for PRI and PSI have visual or visual-motor components, which might account for why his results dipped in these areas. But I don't know whether the statistically significant difference between VCI and PSI would constitute a learning difficulty. When I asked the Ed Psych who administered his WISC-IV, she said no, because a LD would affect him more generally, as dysgraphia does his brother. Yet, now he is at high school, DS14 is exhibiting more of his brother's characteristics (problems with memory, instructions, organization, accuracy, etc.).

The OT did mention the possibility of sensory processing dysfunction, but she only tested his handwriting on this occasion. Perhaps SPD could be the reason for DS14's fine motor skill problems.

I guess I am rephrasing my earlier question about how one draws a distinction between processing issues and learning difficulties.

I've yet to investigate visual processing issues.

It would be great if someone could lessen my confusion!

OT's don't necessarily diagnose. DS gets private OT/PT (since age 4) and they never even mentioned Developmental Coordination Disorder, which DS obviously has. I had to take him to a neuropsych to get a written diagnosis.

Look up Developmental Coordination Disorder on Wikipedia...it talks about all the co-morbities like sensoory issues, spatial processing problems, specific learning disabilities, etc.

Also look up Dysgraphia on Wikipedida. It talks about the different types of dysgraphia. One just involves poor motor skills that affect handwriting. In this case spelling would be normal but finger tapping would be poor.

Blackcat,

It's helpful to know that OTs don't necessarily diagnose.

I am somewhat familiar with DCD, because DS11 has dyspraxic tendencies. They seem a bit different from DS14's characteristics, in that, apart from his fine motor skills, DS14 is coordinated, has good balance and is adept at sport, etc.

Motor dysgraphia seems more likely, if it can exist in the absence of other dysgraphic features.

Shell