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Hi everyone. I posted here this summer about my son, and I feel bad about not being a good, supportive board member (tbh I have horrible social anxiety that sometimes even extends to online ). I really need some advice or insight or something, though. I'll apologize in advance because this is going to be very long. If you actually get through it--thank you!

My ds9 has had a GAD diagnosis for a couple years now and was diagnosed in June with ADHD, along with a provisional diagnosis of Tourette's, by a psychologist (not experienced with gifted). Working with his pediatrician, we have been trying to find a medication that will work for him. We have tried Ritalin, Adderall, and Concerta so far and have seen NO improvement at all. His ped is concerned because she says that when the diagnosis is correct you almost always see quite a difference. She is questioning the diagnosis.

He has so much trouble focusing and gets distracted by any little thing (external or internal). He has a really hard time transitioning and at home I feel like I'm constantly telling him to either start doing something or to keep doing something. Talking with him can be very frustrating because he keeps stopping. At home sometimes it seems like he can't be serious about anything; he's always messing around being silly when he should be doing other things. He takes a long time to do homework, even things that are easy for him. Actually, he takes a long time doing everything-- getting dressed, eating, getting out of the car when we get to our destination (he's usually reading), etc. He seems really immature one minute, and really mature the next.

He has a very poor working memory--every night he has to read for 20 minutes and write a 3 sentence summary, but every time he has to actually look back in the book to do his summary because he can't remember what he read. He was also just diagnosed with an expressive language disorder by a private SLP.

Some background:
He was pretty advanced as a toddler and preschooler--taught himself to read at 2, writing words by 2 and sentences by 3, adding and subtracting at 3, deep philosophical questions at 4, taught himself multiplication at 5. Always very mature, never even had to use any discipline techniques except for explaining why he had to or could not do something. He went to full day, 3 day/week play-based preschool and never had any behavior problems at all there, either.

We started seeing some issues with still having emotional outbursts/mini tantrums in kindergarten and 1st grade, but no attention issues in school. He did go to a martial arts class where he goofed off quite a bit when he wasn't actively doing something. I pulled him out of school halfway through 1st and homeschooled him (he was not learning anything). It was during this time that I noticed he was extremely resistant to doing any work he didn't want to do and therefore couldn't focus on it. Admittedly, I was not very confident in my ability to homeschool and didn't really know what I was doing, so made it pretty much school-at-home. We homeschooled for about a year, but then he had to go back to the same school.

When he went back they put him on a behavior plan because he was still having a hard time controlling his emotions. As he matured, he stopped having the outbursts, but all this time he was having a harder and harder time paying attention at school and at home (when he's not doing something of his choosing). In 3rd grade he started having huge writing issues (went many writing periods not getting a single sentence down) and this is STILL happening. The school is really dragging its feet on evaluating him, but I think they might finally do it soon.

He has taken outside classes and all day camps of his choosing, and had no issues at all. In fact, in some, he commented on how he was the only one not goofing off at times and taking the learning seriously.

Test scores from evaluation in June:
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

He also had the Beery VMI 2 years ago:
Visual Perception 142, 99.4
Visual Motor Integration 99, 47
Motor Coordination 97, 42

Does anyone know what the possibilities are other than ADHD? I'm so tired and confused and just don't know what to do about him. Again, I'm so sorry this is so long. Thanks in advance if anyone gets this far.

sciencelover, what type of professional did the evaluation in June? It looks like you have the typical suite of tests that might be included in a neuropsych eval - was it a pediatric neuropsychologist?

The one thing that I see in the tests from June is that there is possibly a fine motor challenge (evidenced in the discrepancies in the Beery subtests). Your ds' working memory and knowledge categories are also quite a bit lower than his other scores on the SB-V. I am not really familiar with the SB-V so don't know which type of subtests specifically go into which category, but it might be useful to post actual subtest scores here, not just the categories. When you see deviations greater than 1.5 SD (1 SD = 15-16 points on the SB-V, I'm not sure exactly which) it *might* be indicative of either an LD or some type of other challenge. If there is one subtest that is timed and relies on fine motor skills, it would be interesting (and possibly informative) to see if it has a relatively low score.

The "Knowledge" category on the SB-V is also low relative to the othe

The "response set combined" on the NEPSY is also very low relative to his other scores. I don't remember what that subtest measures, but you could google for an explanation of it and try to see how it fits in with what you know and have observed with your ds.

Re what other possibilities - chances are there are quite a few other possibilities. Symptoms and behaviors that are reactions to challenges can overlap between quite a large number of challenges. Some of what you've written above sounds very much like my ds who is dyspraxic and dysgraphic and also has an expressive language disorder. He was also given a diagnosis of ADHD when he was young yet the ADHD "symptoms" disappeared when we discovered he was dysgraphic and had appropriate classroom accommodations in place. I wouldn't make the leap to dyspraxia right away though - these same symptoms could be caused by many different things. FWIW, I had heard the same thing about ADHD meds that you've been told - if you try them and you *don't* notice a difference, that means it most likely isn't ADHD. I don't know how true that is, but that is what we were told by our ped for our dd who was suspected of having ADHD.


Are you sure the things you think should be easy for him really *are* easy for him? I also thought this about my ds in first grade - he was refusing to do math worksheets that were sent home for homework. They were *easy* and he's really good at math. I knew he knew how to do the math. What I didn't know was that he couldn't *write* and that writing was painful for him. It wasn't the math that was the challenge, it was the writing. Deconstructing all the steps in any one given assignment might help understand why he's refusing to do the work. Also look for patterns in what he refuses to do. Our ds sometimes could sit down and complete a writing assignment, sometimes couldn't (more often couldn't). When we looked (over time) at the assignments he was struggling with vs what he could actually get started on and work through - it was the open-ended writing assignments that were difficult (actually impossible in early elementary). Those related back to his expressive language disorder, but it wasn't until he was around 9 years old and finally figured out how to tell us (parents) that he just didn't know what to say that we realized what was happening with writing wasn't *just* about writing, it was a larger issue with expressive language, which is where working with an SLP helped tremendously.

I am going to be back in a few minutes with some more thoughts - need to run at the moment.

Best wishes,

polarbear

Some other possibilities that fit the symptoms that you're seeing--
anxiety
sensory processing disorder(s)-- leading to distractibility
asynchrony of some other non-specified type (?)


I guess given that you HAVE seen settings where he did not appear to have ADHD (camps, etc) and that medication trials didn't help-- I'd lean toward assuming that ADHD is not what is going on.

I'd strongly recommend finding a psychiatrist to work with on the meds. They are far more experienced than a pediatrician.

I'm actually a little surprised they started him on stimulant meds, given that they think he might have tourette's (stimulants can cause or worsen tics). I would think they'd try some of the non-stimulant ADHD meds first.

Thanks so much for the replies.

Polarbear, in response to your question, it was a psychologist who evaluated him in June. She has a good reputation, but her expertise is developmental disabilities (autism specifically) and she just doesn't have much experience with gifted or 2e kids. Unfortunately our insurance limits us quite a bit on where we can go and she is the only psychologist at the center we were referred to. If this next dosage of medication doesn't work the ped might refer us to the big university hospital, where it would take forever to get an appointment, or just send us back to this same psychologist.

I'm not sure what the subtest scores are. The only other information on the SB5 section of the report is:

fluid reasoning: verbal 19 nonverbal 14
knowledge: verbal 12 nonverbal 14
quantitative reasoning: verbal 15 nonverbal 17
visual spatial processing: verbal 17 nonverbal 16
working memory: verbal 10 nonverbal 12

He has said that his trouble with writing is just coming up with what to write. This year he has been allowed to use the computer to do all of his writing and it hasn't made a difference. He did do very well on his last book report, but that was with me sitting there with him, asking him questions for each section. Without the questions to let him know what to say he would just sit there. I really don't think there is a handwriting issue with math. I got permission to substitute part of his homework with Art of Problem solving that he's doing at home, and he has way less trouble getting started and staying on task with that, even though there's more writing (copying the problems from the book). However, there could be underlying OCD issues involved. He hasn't been diagnosed, but he definitely has many of the traits and I know it goes along with Tourette's a lot of times. The problem is that it seems like every professional that I've talked with only wants to look for a specific thing. For example, the psychologist in June only ever considered (and administered the subtests of the NEPSY which could show) whether or not he has ADHD, not whether it could be other things.

I actually got him evaluated by a SLP because of your recommendation back in August and she did the CELF, but didn't put the scores into any kind of context in the report. She did say that he has an expressive language disorder and he'll be getting speech therapy.

HowlerKarma, I am seeing a lot of regular anxiety symptoms along with more and more obsessive compulsive type stuff lately. Every professional kind of dismisses the notion that ADHD type symptoms might be anxiety or even sensory related. He had an OT evaluation 2 years ago and she said he had some sensory issues, but was pretty vague and didn't feel like he needed therapy.

Epoh, I will try to find a psychiatrist who will take our insurance. When he tried Aderall it really increased his tics (which are pretty mild normally), so we stopped it. I will ask the doctor about non-stimulants at our next check-in.

Again, thanks for replying. I appreciate it so much.

Hi Sciencelover. I am not sure I can help you with much but what struck me is that your DS had an almost identical SB V to my DD when she was tested at 7. When she was tested the psychologist turned out to be not familiar with giftedness and took three hours to administer the test, so they probably weren't that familiar with the SB V either. We had requested the SB as it has less reliance on timed elements.
DD was comparatively low on working memory, same scores as your son, and knowledge 11 and 14. She also had the same pattern of strengths. I did some research and the working memory is typically 'low' although in the normal range for gifted kids on the SB V. The psychologist can compute the gifted composite score which excludes working memory.
Our DD was retested at 9 with a tester familiar with giftedness and the SB V and the pattern was the same but the scores were much high, except fluid reasoning which she hit the ceiling on first time. Working memory had improved but was still lower than everything else.
I put low knowledge down to the fact that she was under challenged and so knowledge wasn't where her potential indicated it might be if she fully engaged with learning.
Now with DD we are discovering a few different things. She has hypermobility, probable EDS, which makes writing painful. She has always struggled with writing and is having physio for her generally poor muscle strength and joint problems (multiple dislocations in the last few months). The hypermobility is exacerbated by growth spurts and impending puberty.
The second psychologist emphasized that the strong visual spatial/fluid reasoning profile goes with visual learners who can struggle in audio sequential dominant classrooms and they are often unrecognized for their giftedness. This is becoming more obvious in high school. DD is a slow reader, despite reading very early like your DS. She has to turn the words into pictures in her head and that takes time. The reading load is increasing in high school and making life tougher. Her eyes also tire easily due to the EDS and weak eye muscle control.
DD works a lot better on things she is interested in because it all takes a huge amount of effort, it is hard to direct limited energy sources to things you don't care about. However, it is important for us that DD try at all things to learn as much as she can.
DD is very sensitive and if we didn't acknowledge her easy fatigue, need to be fed and watered regularly and make efforts to adapt to her different needs then I can imagine she would have emotional outbursts too. We have been lucky that she has her fathers even temper.
Not sure what else is going on with your son but have a look at visual spatial learners just in case. Linda Silverman is the guru. Lots of info on the Internet. Check her Gifted Development Centre website. Her book is Upside Down Brilliance. We are having DD assessed with an educational specialist experienced in visual spatial learning on Monday.
We are finding that there isn't one simple answer for anything but we are managing most things.
Good luck. Hope you find what you need. Sending support. I totally get the social anxiety bit!

Just one other thing: The comment about writing, difficulty coming up with what to write, is something Linda Silverman talks about. Kids who see in pictures can have huge difficulties turning their ideas into words. There are so many skills involved in writing, not just the physical act, but all the mental processes of translating ideas into words, that strongly visual dependent kids can be overwhelmed and not able to get started. Add timed situations into that and anxiety becomes a huge issue.
Not everyone believes in different learning styles but I have seen their impact. It's worth adding it to your list of possibilities.

He sounds very much like my DS9 - dx ADHD combined type w/expressive and receptive language processing disorder (although on one of his CLEF categories he scored age-equivalent 5 yrs ahead... go figure).

Anyway, I've always suspected he has a sensory integration issue, and that's the first thing that comes to mind when I read about your DS. Sensory issues can wreak havoc. We've been through countless sensory behaviors and tried every fidget/chew/etc product out there it seems. (Thankfully he no longer eats his pencils, lol). His current quirk is ripping paper "I rip the paper so I can think." I've resorted to covering his duo-tangs with packing tape so that he can't rip them, but he still rips his lined paper and worksheets.

I am also surprised that you were given stimulants for him... my ped specifically warned against them (my DS has also had tics). She suggested that if we try meds we start with Strattera (atomexetine - I think? - a non-stimulant).

Re your comment: "The problem is that it seems like every professional that I've talked with only wants to look for a specific thing." ...ditto!!! Omgosh... isn't it frustrating.

Anyway, best of luck

I thought for an ADHD diagnosis the behavoir had to be apparent in all situations? Sorry can't help unless he has just checked out?

Ndw and CCN thank you for the replies. Ndw, I was surprised his knowledge score was so low, but what you said about your daughter scoring lower because of not being challenged makes me think that is probably true for him. I will definitely look into visual spatial learners. I’ve always known he’s a very visual person, but didn’t realize how much it could affect his life. He is also really sensitive—he can pick up even the slightest hint of sadness or worry in my voice, can’t handle listening to certain music because it makes him too sad, has started crying when something on tv was sad (when he was in preschool the big one was when Steve on Blue’s Clues was wondering why he never found the clues).

CCN, that’s interesting that there was such a gap in some of your son’s CELF categories. Did the tester test all the categories? Our report has all of them listed, but many weren’t tested. I don’t know why. My son likes to rip paper, too! Actually (this sounds so weird) he has ended up eating some bookmarks because he will hold them while reading, rip them into little pieces , and put them in his mouth. We try to make sure he always has gum. I know he needs to get more exercise but right now I just don’t know how to do that when he spends all daylight hours either at school or doing homework (he can’t do it later after playing or he won’t have enough time).

I will definitely ask the doctor about non-stimulant meds.