Gifted Issues Discussion homepage Forums Twice Exceptional Mild adhd and/or possible vision problems

My DS6 has not been identified as gifted but you all have such great knowledge I was hoping to get some advice. Older siblings have been identified as gifted. I have posted about DS6 in the past concerning attention issues. He had a very difficult time in Kindergarten at the end of the year and the teacher said his lack of attention/focus was interfering with his ability to learn. He was not staying in his seat, class clown behavior and testing boundaries. He has been going to a counselor since August and was diagnosed with mild ADHD. Behavior this year so far has been great in first grade with teacher describing him as a model student for listening. We have worked hard on his behaviors but he still has a lot of trouble with focus in other activities such as team sports. He is a high energy kid, always joking and gets in trouble easy when there is lack of structure., He is an excellent reader (highest in his class) but struggles in writing and says he hates writing. He recently had a vision screening at school and they said he has anisometropia. I have heard that vision problems in children can seem like other problems such as ADHD. Is this a possibility for him with this kind of vision problem? He does not see an optometrist for another month. Any questions we should be asking at his full exam? Thanks for any feedback.

Thanks Portia. DS has sloppy handwriting and has difficulty keeping the letters between the lines on the paper. DD 4 already has nicer handwriting. He also struggles to use capitals and punctuation at the end of a sentence. Spacing is an issue if he does not use his finger. When he was younger and just learning to write we could not get him to sit down to do it and he would not color either. He does not seem to have a hard time with ideas but the act of writing. His teacher was concerned that his writing does not match his reading ability at his last conference. I am not sure what this means but I will follow up with her again this Spring.

Hm. So he appears to read well, which suggests that he uses some method that works (perhaps only one of his eyes at a time) while reading, but then struggles with physical written output, despite apparently good oral expression. That would be in line with the act of writing being the problem, whether because of visual, fine-motor, or eye-hand coordination reasons, or perhaps inattention. (In an older child, I would throw in automaticity, too, but most children of this age don't have automaticity for handwriting, so that wouldn't distinguish him from age-peers.) It's possible the absence of binocular vision, or even switching back and forth between the two eyes, may interfere with his ability to coordinate what he sees on the page with his motions. I would echo following up on this with the developmental opto. Vision needs to be ruled out as the principal cause, before you move on to an occupational therapist eval, let alone ADHD. (Just about everything looks like distractibility in small children.)

Thanks so much Aeh. I wonder if his ability to memorize words quickly helps with his reading ability as well. I noticed he picked up reading much faster than his siblings at this age. He is good at remembering words, numbers and math facts. Writing does not come easy and takes much more effort.

Just an update on DS so far. He was prescribed corrective lenses for farsightedness and we are still waiting on the developmental opthamologist referral. DS had his school conference and his teacher said he was a gifted reader and really enjoys him in his class. She is not seeing any behavioral problems his teacher reported in Kindergarten. She does wants him to practice his writing and sent home pages of letters to draw and trace. I was a little frustrated because I already told her we did these all summer with no improvement. She says that he writes his letters from bottom to top and has an odd pencil grip so needs to practice more to get it right. Is this true? Why has he not figured it out by now with practice? Is there something else we should be doing to help him? Thanks for any further suggestions.

So his uncorrected nearpoint vision is weak, which would be consistent with writing challenges, since that's all nearpoint work. You've mentioned previously that he was having difficulty writing on the lines. It may be that his bottom-up letter formation is related to that, or to fine-motor planning/coordination challenges, since one work-around when one has difficulty making two lines meet is to start from where they join. That is, the impetus for forming letters from the ground up may be that then he is always assured that they are on the lines. The odd pencil grip could be an OT issue (hand coordination, grip strength, etc.).

Nice to hear that he is still doing well in class this school year, especially that his teacher enjoys and appreciates him!

It's worth keeping in mind here that his teacher may simply have unrealistic expectations for a boy this age. There's been more than a few discussions on this board of kids getting labelled ADHD or LD for very normal behaviour in 6-year old boys.


However, it's also worth noting that not automating a task, despite practice, is pretty much the definition of an LD, so this is an important question.

It comes down to whether what he is being asked to do is reasonable and developmentally-appropriate for his age, and for a boy. Is he really way behind, or just slightly lagging, or actually quite normal? The fact that he spent all last summer practicing writing as a 5 year-old raises a lot of red flags to me about his school's expectations. As do several other things you note, such as a inability to "stay in his seat" - in kindergarten! - and his teacher's belief that an advanced reader should somehow magically also have equally advanced fine-motor control.

All that to say, definitely don't ignore your own instincts if something feels wrong. Vision issues have undoubtedly made everything much harder for him, and it's really important to find and fix these things as early as we can. But do take a long hard look at his environment, before concluding the problem is the child.

Thank you Aeh! It was a great relief to hear that his teacher likes him. She just gets his humor and does not mind his activity/intensity level. I will give it some time with the corrective lenses and see if his writing improves in the next few months.

Another update regarding DS and his writing. He has had no change since wearing his glasses with writing. No other concerns regarding vision and it has helped with headaches. His teacher continues to complain that he writes his letters from bottom up and has problems with not writing letters r,n,h,m the right way. She just marked all over his spelling test saying he needs to work on this. He got all the words correct. His handwriting looked neat but still not on the lines. Am I being too inpatient? I just don't understand how she thinks practicing over and over again is going to help. He continues to start from the bottom. His counselor thinks it is attention issues. Is this just a normal first grade thing she is being too picky on or should I be concerned?

Letter formation from the baseline up doesn't really sound like attention issues to me. Good that his headaches are resolving with proper corrective lenses. Did he ever get the developmental opto eval? You could have an OT look at him in terms of whether his handwriting and pencil grasp would be considered developmentally appropriate. Especially where I seem to recall that he is relatively young for grade. Is he reversing r,n,h,m? What does she mean by not the right way?

Has he tried HWOT? Or any other explicit instruction in handwriting? Or is he just doing pages of practice? You can also try the HWOT iPad app for reinforcement on conventional letter formation:
https://shopping.lwtears.com/product/CLNAPP/products-by-type