Gifted Issues Discussion homepage Forums Twice Exceptional Thoughts on "Relative Weakness, Not 2e" Diagnosis?

Hi!
I used to lurk here many years ago when my then-4yo's scores had his IQ at the 99th percentile overall and 99.9th percentile in visual-spatial skills.

Background info: I'd always felt that my son's learning curve for reading was far slower than other subjects. He'd known the letters since he was 2 or 3, but couldn't put them together until much later after much specific instruction (vs. other subjects where you could give a basic explanation and it would "click"). As a young child, many people pointed out that some of the things I thought were idiosyncracies were also early signs of dyslexia, like not being able to rhyme.

Now, as a 9yo, he *can* read. He can sound out most words, even pseudo words. But his reading comprehension is -- in my opinion -- ridiculously low compared to his other skills. Like, when I see the books that he reads as a 4th grader for guided reading, I can tell that they're beyond his ability, but he "does OK" according to teachers and is "on grade level". Obviously, this makes me more and more nervous as he gets closer to junior high school, where the "reading for meaning" is going to significantly increase.

We've recently had him tested for what I've been thinking was stealth dyslexia for years, and the results showed (as explained by the neuropsychologist) a "relative weakness" rather than meeting the diagnostic criteria for dyslexia. I have some plans to talk to her again to clear up some of the questions I'm going to ask y'all, but I'd love to hear what the experienced members of this forum think. In particular, do these look like stealth dyslexic scores?

(Also noting that these scores don't show him in the gifted range anymore, but you guys are the most knowledgeable group I know about 2e issues.)

WISC-V
Verbal Comprehension 127
Similarities 16
Vocabulary 14
Information 15
Comprehension 12

Visual Spatial 119
Block design 14
Visual puzzles 13

Fluid Reasoning 109
Matrix reasoning 10
Figure weights 13

Working Memory 115
Digit span 11
Picture span 14

Processing Speed 119
Coding 13
Symbol search 14
Cancellation 11

WIAT-III (There's a lot of these, but I'll just specify the composite scores)
Oral language 110
Total reading 107
Basic reading 116
Reading comp. and fluency 98
Written expression 110
Mathematics 129
Math Fluency 115
Total achievement 115

(I want to note here that he was also given the WIAT-III as a 7yo. Since then, the standard scores for math-related subtests have INcreased by as much as 12 and 26 points (110 to 122 for numerical operations and 105 to 131 for the math problem solving subtest), and the reading-related subtests have DEcreased by as much as 13 and 15 points (111 to 98 for reading comprehension and 115 to 100 for oral reading fluency))

GORT-5
Rate score 10
Accuracy score 7
Fluency score 8
Comprehension score 9
Oral reading quotient standard score 92

In another, test, the NEPSY 2, there were some scores that stood out as well. I won't list all of them, but in the "word generation" segment, he had to name as many animals has he could in a certain time. He scored in the 99th percentile. Then, he had to name as many words that start with a certain letter (I think "P") in a certain time, and that score was in the 5th percentile.

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In particular, I feel a bit concerned with the discrepancies between his math and reading comprehension scores (and standardized math scores tend to be much lower than this when there's reading comprehension involved). And the fact that math has seen a big increase year-over-year while reading is showing a decrease.

The neuropsychologist gave some recommendations for Active Reading Strategies that sounded good. But as I thought more about it, I was like, "I know that he learns/uses these techniques in school already." I feel frustrated for him that he seems to have to put far more work into the reading than he does with anything else and isn't getting the results.

She did also mention that he has signs of CAPD, but the testing she does doesn't fully cover/diagnose that.

Any thoughts? How do these scores compare to your stealth dyslexic? I've since been reading that dyslexics tend to have far more significant defects in working memory and/or processing speed. The lack of problems with pseudoword reading (73rd percentile) and spelling (81st percentile) may also mean that dyslexia isn't really the problem.

I just have such a hard time thinking that his difficulties with reading comprehension are simply due to lack of knowledge or not working hard enough.

I think your thread may have gotten lost in the "new poster hold", so I will get the ball rolling here.

I start by saying your real-life observations are all common things to see with dyslexia, and had me (with a dyslexic DD) nodding familiarly all the way through. Until the final line with the pseudo-word and spelling scores, which were surprisingly high. Still noticeably lower than general verbal ability though. I will leave it to our resident expert aeh to pronounce how seriously to take those scores, given what you see. I will note a couple of considerations though, before you draw any final conclusions on dyslexia.

First, do you have any scores that directly measure phonological processing (say from a test called the CTOPP, but there are others)? These dig a little deeper than pseudo-words and spelling, and are that much harder for a verbally-strong kid to fake. From the scores you've reported, your child does seem to struggle a little more when more context is removed (scores drop from general reading comprehension to individual words to pseudo-words). It would be worth knowing if that pattern continued with direct measures of phonological skills (may be called blending and ellison). Your DS does have nice consistently high scores overall, including in working memory and processing speed. These (especially WM) are often lower in kids with dyslexia, suggesting your DS may have stronger compensatory mechanisms to draw on than some kids. (This is good in the long run, but makes it a lot easier to hide struggles when younger).

Second, the auditory processing issue is important to follow up on, as deficits there can cause challenges with reading that look like dyslexia (if the brain is not interpreting sounds properly/ consistently, it's really hard for it to make the right connections between sounds heard and symbols seen on the page). In other words, even if the testing does show phonological weakness, the cause could be auditory processing rather than dyslexia (or it can be both).

Finally, the good news: regardless of cause/ diagnosis, your son clearly has a reading a weakness, and you are absolutely right that its impacts are about to escalate. OK, that's not the good part, sorry. The good part is that regardless of cause, a quality phonological-based reading program can help him. Our saving grace was a home-based program called "All About Reading" (https://www.allaboutlearningpress.com/all-about-reading/). Your son may be a bit old for it and be annoyed by its cuteness, but it was amazing for us (we used in grade 3 and skipped the cut and paste activities, just doing the actual reading exercises embedded in them). There are other programs like "Toe-to-Toe" which may work better for an older kid, and others here can speak to.

The "relative weakness" thing can be crazy-making when you have a 2E kid. Many psychs are extremely reluctant to diagnose an LD unless key scores are below an absolute threshold (usually 12th percentile), regardless of how out-of-whack those scores are with the rest of the kid. Even psychs really experienced with 2E have told me "the DSM-V no longer allows for a 2E diagnosis". Argh! The best advice I can give is to trust your own observations here, and address the challenges you clearly see, regardless of whether or not the psych is willing to label them. And if the label is important to accessing supports or services, do keep pushing the psych to make full use of all the data you've gathered, together with their own observations and clinical judgment (and not just focus on the test scores). In a pinch, you can also take your results and seek an second opinion from someone with significant 2E experience.

Welcome!

In addition to Platypus's wise advice, I will suggest another category of reading difficulty. It may be that your DC has sufficient phonological processing to decode (hence the strong scores in phonetic decoding and word calling), but lacks automaticity. It is not a bad idea to check that the phonological processing skills are there, such as through a program like AAR (my personal favorite), or similar Orton-Gillingham-based programs like Logic of English (which was designed originally for older learners, so is a little less cutesy). Both are much more affordable than certified OG, Barton, or Lindamood-Bell, and attack essentially the same skills.

However, it may be that building automaticity separately will be where the focus of intervention falls. For that, I would suggest the evidence-based reading fluency program called HELPS http://www.helpsprogram.org/, which takes about 20 minutes per session, with 3-5 sessions per week a reasonable dosage. This is also very affordable (free, if you download it all, and low-cost, if you order the printed materials).

Reading fluency is quite important for reading comprehension for most readers, and there is a notable gap between your DC's word-level decoding skills and fluency. Fluency affects comprehension principally in two ways:

1) Effortful, non-automatic reading leaves fewer cognitive resources for comprehension in general;
2) Slow pace creates additional challenges for making inferences, as content needs to be held in working memory much longer in order to make connections between related elements in the text.

Also, his accuracy falls quite a bit in connected text. Did you get rate percentiles for the WIAT-III Word Reading and Pseudoword Decoding scores, by any chance? That would tell us a bit about whether it's really a question of efficient word calling at the word level, or if we need to look for something else in connected text, such as poor scanning across the lines, poor self-monitoring (such as occurs in students with attention problems or impulsivity--also part of the differential diagnosis with CAPD), etc.

Actually, inattention also affects comprehension, especially #2 above, regarding inference. So in addition to possibly further investigating CAPD, looking at ADHD might also be in order.

And, FWIW:

"The phrase "unexpected academic underachievement" is often cited as the defining characteristic of specific learning disorder in that the specific learning disabilities are not part of a more general learning difficulty as manifested in intellectual disability or global developmental delay. Specific learning disorder may also occur in individuals identified as intellectually "gifted." These individuals may be able to sustain apparently adequate academic functioning by using compensatory strategies, extraordinarily high effort, or support, until the learning demands or assessment procedures (e.g., timed tests) pose barriers to their demonstrating their learning or accomplishing required tasks."

(DSM-V, Specific Learning Disorder, Diagnostic Features, para 5, p. 69)

Thank you both!

I had never heard of automaticity before, and I think I'm going to look into that a lot more. I will fully admit that his phonological processing is generally OKish. Like, he doesn't really struggle to sound words out slowly. Sometimes, though, he confidently mispronounces a new word.

I'd be hesitant to go too deep into a strict OG thing with a focus on processing the sounds. I think he'd be insulted that it was "babyish", and think that his real deficit is in the reading comprehension. The HELPS resources may be just what we need. I've also been thinking about doing a bit with Latin and Greek roots, which could help with spelling/decoding/new vocab.

I also feel somewhat concerned that even while the reading comprehension scores here are coming up comparatively low, I really think that the situation gets far worse when it comes to the "grade level" type reading, like novels for guided reading.

He was assigned this one book, and I looked at it in the library, and smugly thought, "There's no [expletive] way my kid can read and understand this. Surely, the teacher will see what I mean with this." but then when the packet of questions he answered came back, she had written "Great job! This is your best yet!" As I read through his answers, it's incredibly apparent that he doesn't know what he's reading. Some of them appeared to be just plain wrong (according to an answer key I found online), but the teacher allowed them because they were "What do you think?" type questions. I showed copies of this to a friend who's a reading curriculum developer and a retired upper elementary teacher. The teacher friend said, "If this child is being described as bright, there's a problem."

I think that because he generally comes off as pretty smart and together, things like a poorly-worded answer or something that would otherwise show lack of understanding with the text are overlooked.

aeh--I do have the word reading and pseudoword decoding scores (also, in case it's helpful, showing scores from last time he took the test):
Word reading 2018 54(raw) 120(scaled)
Word reading 2015 117(scaled)
Pseudoword 2018 33(raw) 109(scaled)
Pseudoword 2015 115(scaled)

ADHD is definitely a concern of mine. I was diagnosed with inattentive type as an adult. Never would have thought I had it as a child as I was a super-star student (grade-skipped, subject accelerated in math, valedictorian). The neuropsychologist gave him the computer test for that (Connor something maybe) and said that he did fine on that. I think like 50th percentile.

I can definitely see the CAPD. There are definitely times when he mis-hears things, though his auditory tests come out fine. I guess, though, I'm not entirely sure whether I should pursue testing in this area. Like, right now, it seems like it would just make my son feel bad that I keep looking for "something wrong". His teacher has sort of been pushing a narrative of "It's just a confidence issue because his mom's expectations are too high, so he'll do better if I keep telling him what a great reader he is." Like, he tends to make smart choices in the classroom, such as going to a quiet area to work, so I don't know if there's anything that I would need to actively advocate for.

The big bummer about that is that I was really shooting for the dyslexia diagnosis to advocate for audiobooks, thinking that this would improve comprehension, and now I'm not sure that's the case.

I'm also just kind of bummed because I was thinking *finally* the difference in abilities is obvious enough that it might matter, but it seems like it's still not. Really, I'm looking toward trying to pre-emptively fix things that he might struggle with in junior high the year after next. If I'm reading the scores (and the extensive Googling I've done) correctly, it seems like he may have been close to meeting a diagnostic criteria. For instance, there's a 20-point difference between the GORT and the FSIQ, and I think it needs to be 22.5 to count as a "problem". There's also 29 points between math and reading comprehension on the WIAT, which is close to the 2SD difference that usually signifies a LD, right? Although, now that it seems that audiobooks aren't the big solution I was thinking of, I'm not sure that the diagnosis matters.
Anyway, I really appreciate the input and suggestions here.

His word-level decoding scores are pretty good. I actually meant some of the clinical scores that have to do with how quickly he read those words. (You probably don't have those, so don't worry about searching for them.) We can get similar information from the GORT and ORF data, but for connected text, rather than single words. Those measures consistently indicate lower fluency than decoding, in the average range, with comprehension tracking fluency (not surprisingly).

CAPD wouldn't necessarily show up on auditory tests, if they are of acuity, rather than perception. You would need an eval by an audiologist. And the challenge with audiobooks is that if his auditory processing actually is an issue, he might not get more out of text by listening than reading. Additionally, if the comprehension relative weaknesses have their origins in ADHD, audiobooks probably won't help much over reading, although in-person read-aloud may, because of the interaction with the reader. Do you have a listening comp score from the WIAT? Preferably the Oral Discourse Comprehension component score. If text-to-speech is going to be helpful, I usually look for a higher ODC component score than RC subtest score. If it's similar or weaker, that suggests there's not a lot of incremental gain to audiotext.

As to diagnostic criteria: the field doesn't really use hard-and-fast point differences, especially when comparing instruments that are not co-normed or normatively-linked. Also, I should note that his math achievement is a bit higher than would be predicted based on his FSIQ, which suggests that sorting out some of the items in the diagnostic discussion should be a priority, as his measured FSIQ may not be fully representative of his ability.

We are in a similar boat. We had a DD just take the ELLA, and her phonological awareness score came back as a 77 (standard score), in the 6th %ile (which they said was only "low-average" somehow?), but this child also has a number of other skills (processing speed, story memory recall, rapid automatic naming) that she scored very highly on. They did end up giving her the dyslexia diagnosis, but they said that it's a somewhat questionable thing to do because her phonemic skills weren't low enough to warrant it - it's just that they're considerably lower than what you would expect from a kid with her profile. I find it all so confusing!

I'm so late to reply with thanks. I got swamped with work, and then forgot to follow up.
I appreciate the thoughts here, and I especially love aeh's enthusiasm about figuring out these anomalies in the testing data. I always find it so frustrating when the people doing his testing don't think that these gaps are indicative of anything. And I wouldn't have even batted an eyelash at the discrepancy between the FSIQ and the higher math scores, but aeh does. :-)