Gifted Issues Discussion homepage Forums Twice Exceptional Tips/resources for 6yo who is possibly 2e?

DS6 has always seemed "different" in many ways from other kids his whole life - starting from being an incredibly observant baby. We are going to talk to his developmental pediatrician again soon. However, I wanted to see if anyone here any advice for us. He has not been formally diagnosed as either gifted or as having a learning disability. However, we suspect we may end up with either or both of those diagnoses. Despite reviewing the "Misdiagnosis" book, we are having a hard time teasing out what might be related to possible giftedness and what might be more of a concern.

He seems to have many incredible strengths, including: number sense, ability to categorize information, making connections between different content, a very strong memory, and he has also been able to read since he was 3 years old. He can decode pretty much any word and read with fluency - although he sometimes reads too quickly. Recently, it has come to our attention (partially by observing him at home and partially from comments his teachers have made this year) that he has some trouble comprehending fiction texts. He seems to be very advanced in both his reading and comprehension of non-fiction texts - independently reading and seemingly understanding books appropriate for late elementary or middle school students. I am not sure if he is below average for a 6 year old in his fiction comprehension or not, but his comprehension is WELL below his non-fiction comprehension. I am a bit worried that the discrepancy between them might be a red flag for something.

While he has many strengths, he does struggle a good bit with social skills, as well as with anxiety issues. He grinds his teeth at times, wanted to stop going to a weekend class because there were other kids in his class, doesn't always look at his teachers when he asks them a question (sort of speaks into his own chest), has a very hard time initiating friendships or even conversations, and things of this nature. The other kids do seem to like him, but he has had a lot of trouble this year standing up for himself in social relationships. He is also incredibly concerned with what others think of him and doesn't want to stand out in any way. He is a very sensitive child. He has had sensory issues that required OT in the past. His developmental pediatrician also told us a few years ago that if PDD-NOS was still a diagnosis, he may have been diagnosed with that.

He is a generally happy kid at home, although he does have rigid thought-patterns and have difficulty with abstract or creative play. He really thrives with structure. At school or elsewhere, he enjoys it after he can get comfortable, but his teachers described him as quiet - which he is not at home. In any event, my husband and I feel so confused about how best we can help him. We would appreciate any thoughts, tips, or suggestions from anyone who has been there or done that. He has not yet had a neuro-psych evaluation done and we are also wondering if that might be a good idea at this point.

Are you raising my son? It sounds like it. FWIW, he ended up with an autism diagnosis at age 8. When you say, "if PDD-NOS was still a diagnosis, he may have been diagnosed with that," be aware that all of the diagnosable stuff was supposed to be collapsed into the autism diagnosis, not eliminated.

If you get a neuropsych evaluation, I recommend that you get it from someone familiar enough with autism to feel comfortable diagnosing it if s/he sees it. Our first evaluations (of both kids) were with a highly-recommended neuropsych who missed it entirely, in both kids.

Anxiety and social language issues and sensory issues are all 2E issues. Maybe you meant to say finding learning disabilities? I agree that a neuropsych is more likely to spot those.

Thank you all so much for your comments. It is nice to know we are not alone on this journey!

Autism may very well be what he ends up being diagnosed with. We are certainly open to it. His developmental pediatrician did not think he had enough symptoms to be diagnosed with autism when he was seen a couple of years ago. We will see if there are more signs when he gets seen again soon.

Portia, thanks so much for your comment about the best age for a neuro-psych. This has also been something we have been wondering - if he is too young for it to be as helpful as it could be later. But, if he is having some problems if it perhaps worth it to get it done now anyway. His age is definitely something we are considering.

The idea of looking at social stories is a good one. I will try to do more of that with him. I do try to ask him those types of questions when reading stories, but he often doesn't have much to say in response to them. I am planning to seek out a therapist to help with his anxiety/social skills and I will inquire about social skills groups, as well. I have also wondered in the past, spaghetti, if he has some issue with social language. He speaks very clearly and has used many words since a young age. So, I had never considered a speech/language therapist before, but I have begun to wonder more recently if this might be part of the issue for him.

His spatial skills seem pretty strong. He loves geography and can make connections between shapes of countries to something else he sees. He also LOVES building with blocks and legos and has for a very long time.

In looking at the criteria for social anxiety, I'd say it's highly likely that is what he has (perhaps with other things too). In terms of his expressive language, he knows ALL of the kids names at school and tells us lots of details about them. However, he does lack a "narrative" when describing his day or telling a story. He sort of jumps around some which can make it hard on me to really determine what happened. I'm not sure how normal that is for six year olds or if that may be a sign of a problem. With his writing, he has lots of ideas but just needs help seeing how to put them together in a narrative/organizing them. Again, I don't know what most 6 year olds look like in this regard. While physically forming letters has been hard for him at times, he is at grade-level according to his teachers now. And, he loves to write stories and books. Mostly, he prefers to write non-fiction, though.

In regard to finding the anxiety or social language issues, spaghetti, what would be better than a neuro-psych? Just an evaluation by a therapist for the anxiety or a speech/language therapist for the social language issues?

Thanks again, everyone! It has been very overwhelming as we figure out how best to help him. I really appreciate any and all guidance you can offer.

Many of the persons who previously would have been diagnosed with PDD-NOS actually do not end up on the autism spectrum now, but more accurately belong in the diagnostic category of Social (pragmatic) Communication Disorder. Loosely, it's all the social communication and interaction symptoms of ASD, without the restricted/repetitive behaviors.

The neuropsych could be very helpful early on, especially in the hands of a good clinician, but with the understanding that the absolute numbers probably would not represent the actual potential of the child, just their current levels of function. (This, btw, can be true of any evaluation.)

A speech language pathologist can also assess pragmatic language, but you might have to point that out in the reason for referral, so a little more time is spent on that. It may be, though, that there are also other language issues which are contributing to social challenges.

Personally, I lean on the side of comprehensive evaluations, rather than piecemeal ones, but speech/language and sensory evals would be separate people from the neuropsych anyway, so you could start from there. (Neuropsychs typically only cover cognitive (IQ), executive function (which may include memory & attention), social-emotional, achievement.)

Actually, portia, I think your perspective and contributions as an experienced parent are extremely valuable, and always spend a moment to consider them when I see them.

FWIW we first tested DS at 6.5 and had to retest at 8.75. I agree with Portia that waiting will likely result in higher accuracy but at the same time for us the results at 6.5 were HUGELY beneficial in pointing us in the right direction. I think the first set of testing allowed us to peel a layer of the onion. If I could only afford one round then I'd wait but if you are lucky enough to have good benefits or can afford it I wouldn't say that testing earlier is not going to be helpful. I echo the recommendation to find a 2e expert - having a psych that we trusted completely was essential to this adventure.

I also agree with Portia's comment above about not connecting. My DS is an INTENSE kid. Pre-K he was speech delayed and had a really hard time expressing his intense emotions. Even when his speech caught up I think it still wasn't enough for him to be able to express things when he was at his most intense. We've spent years working with him (The Explosive Child saved us) and he's now 10.5 and I feel like we're almost caught up (or at least most days).

For the fiction/non-fiction. My DS wasn't interested in fiction until he was older (I'm going to say 8ish?). George's Secret Key to the Universe was the gateway book. It combined his obsession with black holes with a fictional story so for him it was a perfect combo. After that he got into the Hobbit, Lord of the Rings, Harry Potter, the Riorden books and never looked back. His reading wasn't particularly advanced early on so I think it took awhile for his reading level to get to the point where the books had enough meat to sustain his interest if that makes any sense.

how likely is it that a child with a social communication problem (in terms of understanding or comprehension, at least) would do really well on the fictional portion of tests like MAP and do better on fiction than non-fiction? As in, 99th percentile. DS didn't do all that well on the pragmatics profile of the CELF but does not seem to have a problem understanding high level concepts in fictional books. Just curious if anyone has thought about this.

It depends on what the nature of the pragmatics deficit is. For example, if it has to do with reading nonverbal communications, many of which are visual in nature, then comprehending fiction would not necessarily be an issue, as all of the nonverbals have to be written out; it might actually level the playing field, or even give an advantage, to readers who rely heavily on verbal cues for reading social situations. Or if they have sufficient cognition to decode social situations using rules, they might be able to figure it out in text, where you can re-read, and slow down the process, but it may still be too difficult to keep up with social perception and social cognition at speed, in live settings.

If the origin of the social communication difficulty is more linguistic, such as getting inference, figurative language, etc., then reading comprehension might be more of a challenge.

Thanks for your input. I think reading non-verbal cues is probably the main issue, although I can't put my finger on why exactly this is an issue. He does seem better on a low dose of stimulants though, in terms of staying focused during conversations rather than wandering off topic, maintaining eye contact, etc.