Gifted Issues Discussion homepage Forums Twice Exceptional ADHD? Gifted? What to do?

So we recent got the results of DS10's neuropsych testing. He did demonstrate some attention problems, but not enough to really be diagnosed as ADHD, mostly because he does not exhibit the problems across multiple settings. Basically, when he is engaged and intellectually interested, he has no issues at all. But when he isn't he is quite difficult. I just checked with his accelerated math teacher who said DS is wonderful in class and seems to be on task. No issues there. Homeroom teacher noted "staying on task" as a problem in the recent progress report, but when I asked for more details she said he needs reminders to get started but then does what he's supposed to do. She also said she's taught kids with attention problems before and doesn't see that in DS. Whereas, last year's homeroom teacher was constantly criticizing him for not being on task, wandering around the room, etc. It was pretty bad by the end of the year.

I'm starting to get a feeling of "It's not him, it's them." It seems if he is at least moderately intellectually challenged, he's ok. The math accel is one year advanced which still is below his performance on the achievement test the pysch gave, but I guess its enough to keep him focused. One big problem is writing. He resists writing and the gifted program emphasizes this heavily. He did not come up as dysgraphic, but he does have delayed fine motor skills which make writing a chore for him. He has also become really anxious with anything timed (Otter Creek math facts especially). I think there may be frustration as well that it is hard for him to write what he is intellectually capable of because his thoughts are way more advanced than his hands. So he tries to avoid it altogether. I do think he would be better off if he could dictate or type as his typing develops.

So, I don't know what to make of things. We have a follow up visit with the psych in a few weeks. She said that she is willing to diagnose him with ADHD in order for him to receive accommodations, but I don't know what to think about that. If we don't officially diagnose him, he gets no guarantee of accommodations, which could potentially keep him out of the gifted program in middle school if the writing catch up significantly. I feel that actually, his "attention-deficit" is actually intensity/overexcitability, just an intense need for stimulation. I also feel like his sensory processing disorder is similar. He is a sensory seeker, not necessarily because he is "undersensitive" but because he physically and mentally craves physical stimulation. As he's matured, he is better able to control these things, but he still melts down sometimes. I always think of that nursery rhyme, "When she was good she was good, but when she was bad, she was horrid." He can be mature beyond his years one minute and having a toddler like temper tantrum the next. But the tantrums are getting farther apart, thankfully.

So, I don't know where I'm going with this. I want to make sure that his educational environment meets his needs. Is getting the ADHD diagnosis the only way to guarantee that? It is frustrating. Any advice is appreciated. Thanks!

Has he learned keyboarding? Any chance you can get a casual accomodation for him to type some work?

My 7-year-old (almost 8) has ADHD. If it is possible, go into the classroom and observe him. When I did this a couple years ago I saw obvious and striking differences between DD and the other kids. DD was just fine with reading and would stay on task, even in the classroom. But math and writing were different stories. One thing that I need to point out is that people/kids with ADHD ARE capable of focusing on things that highly interest them (sometimes hyperfocusing). So DD, for instance can put together a 100 pc. jigsaw puzzle in one sitting or read 3 chapter books in a row even when she's not on her meds. She can get obsessed with ThinkFun puzzles and complete puzzles that most adults would give up on after a minute. But if you ask her to do something that is not completely engaging to her she falls apart, even if she WANTS to do a good job. In this way it can be hard to differentiate between a gifted kid who is simply bored, and a 2e gifted kid with ADHD.
In the classroom (when not on meds), DD is highly distractible with written work and spends most of her time looking around the room at other kids. She is incredibly SLOW and her processing speed seems off. She will get "lost" in the hallway, chatting with people rather than going to wherever she is supposed to be going. If your DS is on task most of the time and can get work done at the same speed as the other kids (assuming he is trying), he probably doesn't have ADHD.
You may also want to ask about Developmental Coordination Disorder. Fine motor skills like writing can be affected even if there is no dysgraphia.

I would not agree to an ADHD diagnosis with confirmation from so many different sources that ADHD is not an issue (and most likely not present per the neuropsych eval). Instead, I'd seek accommodations (504 plan) with a medical diagnosis for the fine motor delay. I'd also try to find out if you have a local parents' advocate group that you can call for advice (there are groups in all 50 states, funded by the Federal Govt., and in our state we were able to get advice while advocating for IEP/504 plans at no charge through them. I found them quite helpful for calling up with simple questions, and also found they often had answers to my questions that I'd never considered or knew about. For instance, when my dysgraphic ds was in 3rd grade and I was not able to get him any accommodations at all in his classroom, I found out while consulting with our parent advocate that in our school district, starting in 5th grade, any student who can type faster than they can write, is allowed to type their classwork and homework. Simple as that. It's a policy I never would have thought to look for, and it's a policy that I suspect most of the *teachers* don't know about, but if my ds' school had been so bullheaded about accommodations (excuse me, I mean if my ds' school had not been so overwhelming cooperative as they eventually sorta became lol) I could have relied on that policy to insist that he be allowed to type.

Did the neuropsych diagnose your ds' fine motor delay? Did he/she suspect it is remediable (if that's a word lol). Did he/she recommend OT? If it's something that will improve with OT, I'd get your ds into private OT (I'm assuming he doesn't qualify for school OT, but even if he did, I think with this I'd go private just so you can be sure he gets what he needs and in a timely manner). If fine motor is what's impacting handwriting, and it can be successfully remediated, you have an avenue to guarantee that handwriting isn't going to hold him back when he enters middle school (unless you don't do anything to resolve the challenge).

FWIW, there are two potential issues that may come up if you *do* decide to go for the ADHD diagnosis - first, having the diagnoses doesnt necessarily guarantee accommodations will be granted, and if you *do* have accommodations agreed to by the school in theory, that doesn't always work out to mean they are given in practice. Hopefully your ds' school will be a school that will work with your ds and give him what he needs in terms of accommodations, but if the school seems to be overly agreeable to ADHD accommodations but unwilling to accommodate for a fine motor delay, I'd be suspect that they are going to be easy to work with even with a diagnosis.

Second thing - my ds had an ADHD diagnosis through his neuropsych at 8 years old which was later determined to not be accurate. Once that diagnosis was in his school records, it popped up again later, after we'd already determined through private testing and a second neuropsych eval (by the same neuropsych) that he does not have ADHD. Guess where it "popped up"? In an IEP eligibility review meeting, written on his school paperwork, with a question from the staff - is he medicated? We had to go through yet another ped ADHD eval to show that he did not have ADHD simply to get the question off the table at future team meetings at school re was he medicated for ADHD - because his school staff was quick to assign all issues to ADHD as the cause (which it wasn't) and then to bring up the question - is he medicated. So that's just something to be aware of - hopefully wouldn't happen, but you might face that question.

It's also been our experience that in advocating for our ds, it's been helpful to have the official "non-diagnosis" that our ds is not ADHD - because he needs accommodations for other reasons. Teachers in our school district are very used to seeing students in their classroom who have ADHD diagnoses and some symptoms and behaviors overlap. So the teachers we've known tend to jump to the conclusion that something that looks like ADHD in the classroom is ADHD - and perhaps the accommodation or remediation for whatever the root cause is and ADHD might be the same, but otoh, sometimes not (more often not for our ds). So - it was best for our ds to not be id'd as ADHD not only because he doesn't have ADHD but also because it helped us avoid accommodations and assumptions from teachers who didn't bother to understand what was really going on.

Hope that makes sense!

BTW, my ds has a diagnosis of Developmental Coordination Disorder. I am going to guess that if your ds has had a neuropsych eval and didn't have that diagnosis come up, he most likely doesn't have it - it's a diagnosis in the DSM-IV. That doesn't mean he doesn't have fine motor delays, just means they most likely aren't a subset of DCD.

Best wishes,

polarbear

My DS9 (almost 10) has an ADHD diganosis. We have used his diagnosis to get accomodations in his HG classroom that include additional time to complete work (this is really only used when the work is writing or below his level) and less problems to indicate mastery, allowing us to type for him on larger projects and/or him to type. He can also chew gum in class to help with focus. Your post sounds very familiar to me because still I wonder how much of his issues are giftedness (ie still not quite fitting in the classroom) or ADHD. There are many other similarities to my DS (writing, fine motor, still occassional major meltdowns, intense need for physical stimulation - very active, resists (ie fails to increase speed for) timed activities) and what you describe with your DS. I have said many times I don't think he has ADHD until he does something that shows he does. It's definitiely harder when school is in session.

My kid has never been the 2-3 years lagging in maturity and/or executive function that I often read about or that blackcat mentions with her DS. I have seen significant growth in the last 2 years. I will tell you what we did in terms of trying to find the right educational fit before we went down the road to getting the ADHD diagnosis.

He was one of the oldest for his class so, although he was a little immature, he skipped a grade mid year from 1st to 2nd. After that, we got him into a HG self contained program in a neighboring district. The classroom was a 3/4 combo so he was still 7 while a few kids were already turning 10. A few months into it, he was struggling socially and with written output (he still struggles with it - I guess when I say struggles - I mean he cannot output what is in his head)so we had him assessed further to see what else could be going on. We essentially had the same conversation with our neuropsych that you have described and just decided it would be better for him to have that protection and to not be penalized because he is slow and immature. He is much better and quicker at work that is at his level so when we have that, he seems to be able to focus much better and pick up the pace a bit.

He is PG by DYS standards and we have not medicated. I do give him omega daily and a multivitamin and we try to eat healthy in general. We are an active family so we try very hard to have some fun activety as part of our day - with school and work it is not always possible but on the weekends we always do something physical. My husband wrestles for fun regularly with my DH and that seems to work to feed his senses.

I tell you all this so you know what we have tried before and/or during going down the road of a diagnosis for him even though I cannot (nor do I think anyone really can) tease out what exactly is ADHD and what exactly is gifted intensity/overexcitability.

Good luck.

Just occurred to me there might be some interesting flow on affects to accomodations. I am quite sensitive to sounds and smells - having someone chewing gum in the room would really stress me: it is banned in my house. I wonder whether I could get earmuffs with a sound link as an accomodation for that? :-)

Thanks everyone for your comments. It is good to see how your kids have faired with and without diagnosis. I went back to the rough draft of the report I was given and found the actual attention and concentration tests that she gave him during the evaluation. On the Children's Color Trail Test 1 he scored in the 1st percentile which translates to "moderately impaired". Then on the more challenging CCTT 2 he scored better, 24th percentile or average. She also gave him Conner's Continous Performance Test II and the results indicate "that chances are 99.9 out of a 100 that a significant attention problem exists. His profile is similar to an ADHD clinical group.

So basically, if I read this right, the tests she gave him definitely suggest an attention problem. However, it was ameliorated by more challenging material. She also noted, as has his gifted teacher, that he would miss some easy questions during the examinations, but answer harder questions correctly.

What prevents him from easily being classified as ADHD is that the behaviors are not consistent across environments. It seems that he is ok when he is engaged but apparently less able to tolerate rote or uninteresting tasks than other kids his age. Is that ADHD? I don't know what to call that.

My own observations, he has always had a much better attention span than other kids with regard to things like listening to stories, going to plays, movies. Anything where he is being mentally stimulated. However, he bounces off the walls in "down time". When he was younger we were constantly going somewhere (museum, library, park, etc.) because he just didn't tolerate hanging around the house that well. An example, if he's watching a television show he will be very involved in it, but as soon as there's a commercial break he is up literally bouncing on the furniture, jumping around, often bothering his siblings. When the show comes back on he sits down and watches quietly again. He's 10 and that has been true since he was a toddler.

We have another meet with the psych on the 28th so I have the opportunity to task more questions.

I don't want to get the diagnosis if its inappropriate. But I'm having a hard time understanding what this is and what to do about it.

Part of the issue with ADHD, that often gets overlooked, isn't just hyperactivity or attention problems - it's an overall delay in executive function skills. Kids with ADD/ADHD have difficulty following multi-step directions and have difficulty considering the consequences of their actions prior to acting, among other things. Kids with ADD/ADHD are often impulsive in odd and sometimes dangerous ways. Both of my kids will do things like- attempt to get into the tub while still dressed, attempt to put on shoes before socks, sit down to eat without getting a fork/spoon, take a drink out of the fridge and set it on the counter and then walk away, etc, etc. Just this morning I watched my son start to put on a pair of shorts before taking off the pair he was already wearing! My husband is forever carrying the remote around the house, setting it down, and then having to search high and low before he finds it again (I once found it in the freezer!)

Length of attention span, IMO, is the least important aspect to ADHD. Some kids just develop that slower than others. It's the impulsivity and inattentiveness that has been the biggest factor in my husband and children needing treatment.