Gifted Issues Discussion homepage Forums Twice Exceptional Gifted Overexcitabilities or ADHD outbursts?

Well, the appointment went well. The plan at this point is to definitely pursue counseling as well as a med change. DS7 took 27mg of Concerta this morning, and while he's not hyper, he's definitely not focused. She commented that in the absence of anxiety, she'd certainly recommend an increase in his Concerta dose to 36mg.

However, she feels that anxiety is a definite, and she spent a lot of time with me and with my son. She also had the teacher, my son, and me fill out questionnaires to help narrow down anxiety triggers and to rule out other diagnoses, such as OCD, OCPD, Social Anxiety, etc. She feels confident in a diagnosis of generalized anxiety. I asked about OEs, and she's of the philosophy that it doesn't matter what you call it. It's still anxiety. She also differentiated between intensities and anxiety and stated that he had both. She said some kids are intense, but it doesn't necessarily cause them anxiety that interferes with function. We also talked about the fact that anxiety and perfectionism are very common with gifted children and can be exacerbated by the ADHD. She recommended some good books as well.

She said we can try the 36mg Concerta for a few days or a week to see if that helps or makes things worse. If this doesn't work, she wants us to try the lower dose of Concerta with Straterra. Of course, he'll be getting counseling as well. She said we can just start with the Straterra and the lower dose Concerta if we are not comfortable with increasing the Concerta. Personally, I'd like to try to increase the Concerta first (small changes before big changes are more comfortable for me!) and then try the Straterra if that doesn't work. I'm not overly optimistic about this, but it's worth a try. At least with stimulants, you know right away whether or not they're going to work and whether or not they're going to cause major side effects.

The doctor thinks that counseling and anxiety management strategies will work well for ds b/c he is bright. She thinks he'll be able to learn the techniques and put them to use. If not, she did say an SSRI could be a next step. However, she also said that studies show that SSRIs are only effective for about 50% of people who take them for anxiety. She believes the success rate is actually even lower than that due to placebo effect. So, we're open to the idea if it's needed, but for now we're going to take baby steps. If we jump to the SSRI, we won't know if it's the medication or the counseling that's helping.

She's not prescribing Straterra for the anxiety. It's to enhance the stimulant if ds is unable to tolerate a higher dose of the stimulant.

So, basically the anxiety treatment will consist of counseling and implementing anxiety management strategies at home and at school.

The doctor loves Montessori education, but she did caution us to be aware of their level of flexibility with skipping steps in the Montessori process. She said even if they allow him to work at an increased rate but still go through every step, this probably will not satisfy him because of his resistance to do things he already knows. Of course, as we know, she said this is typical with gifted students.

She did say, though, that because we live in a less-than-ideal world, it might not be a bad lesson for ds to learn that at times he will be required to go through mundane steps to accomplish a task. Her measuring stick with regards to how much of this he can tolerate is to see whether or not he wants to go to school. If he's happy, likes school, and continues to want to be there, then that's a good sign. If he begins not liking school and not wanting to be there, that's a red flag, and we might want to consider other school options. I will be talking to the teacher, counselor, and administrator (headmistress) about acceleration, however.

Now, speaking of acceleration and neuropsych testing, what would you guys recommend? We are open to a complete battery of tests if that's what it takes to get ds the education he needs. Public school is not an option here unless we can move. And, in this market, that's not happening anytime soon.

I'd like to do more gifted testing as well. It's been a couple of years since his last testing, and he was not on medication at that time. Also, I'd love to know if there are any LDs going on. I really don't think so, but I know sometimes with bright kids, it's not immediately evident.

What do you think about achievement testing to help with grade-level/academic-level placement? Any suggestions? I feel like the teacher is probably thinking it doesn't make sense to increase the challenge if he can't do the easy work. I know that logic makes sense with many children, but not with my ds and not for most gifted children. I don't know how they will be able to know what level he is in any given subject. Is there some kind of test?

For example, he can add and subtract, of course, but he's not super fast with it, so he hasn't been allowed to move on to multiplication or division. When I was homeschooling, he was able to do multiplication and long division. "After-schooling" is a nightmare b/c by the time he gets home in the afternoon, he's very resistant to anything academic. Plus, we're paying out the nose for this school; my son needs to be learning something. This was something I had a hard time with when homeschooling. I didn't know how to move in any kind of logical order, especially with math, because he's capable of so much but limited by his interest level. Does that make sense? Ok, I'm rambling. Long day...

Thanks guys for all the support and advice. It's been a huge help.

Hi Jen,

Your DS sounds rather a lot like mine in the pairing of anxiety/perfectionism with attention issues that lead to upsets at school. Ours has Asperger's, so YMMV for anything I say.

Your current treating professional--psychiatrist?-- what kind of testing information is she operating with in making her decisions? Some questionnaires, or something more rigorous? Is she a specialist in ADHD/gifted?

For our DS, to diagnose the Asperger's, they did a full neuropsych workup. This included unbelievably detailed developmental history, questionnaires for us and teachers, IQ testing, academic achievement testing (you asked about this--it measures what he knows), language testing by a speech therapist, the ADOS (autism rating scale), Conners' rating scale, the Vineland test of adaptive skills, and more. Close to two full days, with breaks. (We were lucky this was covered by insurance.) After which we came out with an incredibly detailed picture of strengths and weaknesses, including the giftedness and the social deficits and the rest.

I think if you're not sure what's going on with your DS in addition to the ADHD, this kind of testing is probably a smart idea-- if your tester is really sharp, they can tease out what the precise issues are, which can affect your decisions. Yes, ODD, ADHD, and AS can all look quite similar, or be comorbid, and some of the treatments are the same, but some of it's different, and you'd want to know what you're treating. I'd be very careful about choosing a tester, to find someone with LOTS of experience with 2E kids.

The achievement testing would let you and the school understand what work your DS can actually do, and the IQ testing might indicate his potential-- then you can start to make decisions about what's appropriate for him. Coming at a school with data is very different than just saying "but I know he's smart" when they are having a hard time seeing it themselves.

My DS hated homework, too, because he resented school so much in grades K-1. This has gradually improved with loads of positive reinforcement and treating the anxiety.

Nailing down the gifted numbers with IQ and achievement testing turned out to be important for us; getting DS placed correctly in school has helped him be happier, though it is not even remotely a cure-all. Anxiety is real, and it takes a lot to change those thought patterns.

I will say that for us the SSRI was extremely important. DS could not even access the therapies for improving his thinking around anxiety until we got him down from fight-or-flight mode with the meds. Once he was feeling calmer and more rational, the cognitive therapies "took" much better.

We also believe that DS was suffering tremendously. He sure wasn't wanting to have all those panic attacks, especially at school where it was embarrassing to be out of control, and it became imperative that we treat the anxiety by any means necessary. For us, anxiety interfered with learning.

We have found a developmental pediatrician who specializes in AS who gets the gifted piece and is reasonably conservative in her approach; she talks to us and DS for a long time before any change in meds, and has vastly improved our lives. YMMV.

DeeDee

My DD just turned 8 and sound very similar to yours in so many ways. She is PG, has ADHD and her perfectionism is crippling. She doesn't want to do work that is too easy because it is 'boring' and she won't dare attempt anything hard because she can't do it as well as she wants. Her anxiety is a huge issue right now. If you have any good anxiety management strategies to share, please do. DD is also seeing her psychologist regularly.

I don't have any advice to share.. I wish I did. Just wanted to let you know that there are people with similar struggles. It is incredibly hard to send my girl to school each day and know how hard it is for her. I just want to fix it and I can't.

Aside from the meds (discussed earlier in the thread), we have taken several approaches to anxiety management. This is a work in progress for us.

Part of the problem is that gifted kids are so unused to making mistakes in school that they don't really understand that everyone does all the time, that it's totally OK. It is important in school to be working right at the child's point of difficulty-- where the work is possible for them, not too hard, but hard enough that mistakes will happen-- so that they can have this experience. Our teachers are working on giving DS supportive feedback about mistakes that emphasizes that this is normal learning.

Some of what we do at home is problem-solving training in general: "OK, it's not right, how can you fix it to make it right?" Not only for academic work, but for any situation-- a dead battery in a toy, a ripped piece of paper, anything. Feeling like you can have another go at something, or repair the mess you made, is useful.

Part of it is just having more experience in accepting undesirable outcomes graciously. We praise DS when he makes a mistake and deals with it, or copes with adversity, and we explain why this is important. We play games where everyone loses sometimes (games of chance, and games of skill, both, and we talk about the difference)-- and we practice losing graciously at both kinds.

We parents also routinely point out when we make mistakes. Sometimes I make a wrong turn on purpose in the car, just so I can model that it's no big deal, I'll just go back the other way and the mistake will be fixed.

And we often emphasize process over product--"You did that really well, you must have practiced"-- if we know he did practice. If someone's better than he is at something, we suggest they might have practiced a lot, or have a talent for it, or both. He gets praise from us if he notices and compliments what others do well.

All of this is having some effect, though it is going to take a long while to make it part of his operating system.

DeeDee

Thank you guys. I am so tired, so hopefully I'll make sense tonight! First of all, we have had gifted testing done, but I'd like to have it done again now that ds is on medication and can focus better. Deedee, thanks for clarifying what all is involved in a more comprehensive assessment.

The neuropsych testing sounds like the way to go, but I'd really like to find someone good. I've been searching, and I can't find anyone who specializes in working with 2e or gifted children in my area. We'd be willing to travel if necessary to see the right doc. We just want some answers. I'd hate to think my son is continuing to struggle simply because we're barking up the wrong tree.

If anyone has a neuropsychologist they'd recommend, please PM me!

Our doctor is a developmental behavioral pediatrician who specializes in giftedness, ADHD, and ASDs. I love her, and I am repeatedly impressed with her level of knowledge of treating 2e children. She used our gifted testing results/report, developmental testing done at her office (I'm not sure exactly what this entailed, but it was definitely not all that is done in a neuropsychological eval.), a very thorough history (I was digging up my baby books and calendars from my son's first year, reports from teachers, family history, etc.-took a very long time), physical tests with my son, and questionnaires from my husband and me and the teacher. These were also very long and detailed questionnaires. She has follow-up questionnaires that we and ds's teacher complete periodically to measure progress, but these are only a page or two each.

Deedee, our doc recommended many of the strategies you mentioned. I can't believe I never thought of playing a game that didn't have a winner or a game where the loser actually gets a prize. I guess the idea is to dis-associate losing with an extreme negative feeling and replace it with a positive. That way the child can focus on the process and enjoy the game rather than worrying about the outcome.

I read in one of my books today that another good technique for kids who have difficulty with team sports due to anxiety (my son) is to use team-building activities. This would be good for siblings, classmates, or club members to do together (like the things office employees will do together for team building). They all have to work together to complete a task or reach a goal, but they are not working against anyone. I'm going to talk to my son's teacher about trying to incorporate some of these kinds of activities into recess.

Right now, ds wanders around looking for an activity that appeals to him, and is intimidated by trying to interject himself into other kids' games. He ends up doing nothing and is planning to ask his teacher if he can just bring a book to recess.

Kathleen'smum, thanks for sharing. It REALLY does help to know you're not alone. I'm sorry your child is experiencing the same struggles. It's very upsetting not to know how to help your child. We're doing our best and searching for answers, though, right? My son tends to be a happy little guy most of the time, so I know I should count my blessings. I just hope we can get a handle on what's going on with him so he can feel good about himself all the time! Good luck to you too. Hopefully some of the info here will help.

Thanks Deedee and everyone for your help. I'd REALLY love to hear suggestions or neuropsych recs. Thanks!

Jen, since you already trust your dev. beh. ped.-- how about asking her for a recommendation?

DeeDee

I will definitely do that. I wish I had read your previous post before I was there today. ; )

I am planning to call tomorrow. I just have my doubts that there will be anyone experienced with 2e children. Hopefully I'll be pleasantly surprised.

Thanks again. Good night!

Well, I called the doctor, and she only had one recommendation. The neuropsych she recommended is near the pediatrician's office (2 hours away), and she only recommends her b/c she's really the only one around.

So, I checked in my area, and I found a couple, but none of their websites even mention the word "gifted". I don't know what to think about that. I called one today, and she said she'd be happy to sit down with me for a one-hour consultation, look over the previous testing/evaluations, and recommend (or not) further evaluations. Is this typical?

Also, I was looking over ds's gifted testing again, and he has a 24 point difference in his verbal IQ and his nonverbal IQ scores. The verbal was higher. Could this indicate a nonverbal learning disability? I did a little research on it, and some of the characteristics fit, but some do not.

When the testing was done (age 5), I discussed the results with a gifted teacher friend of mine (who also has gifted children of her own) and she pointed out the discrepancy, suggesting a possible LD. I asked the psychologist who did the testing, and he said LD was unlikely because both scores were considered advanced. Now I'm wondering if he just didn't have enough experience with 2e kids.

Any experience with this? I'd love to hear what you all think. Thanks again.

Oh, wow, that's tough.


Sounds like an OK deal, actually; you'll get a sense of whether she asks the right questions and starts to build a correct picture of your DS before investing in hours of testing.


This is out of my area of expertise in terms of technical understanding of the tests. (Dottie?)

But based on our own experiences it does happen that doctors overlook problems because the scores overall are so high that you "ought" to be delighted-- even though those dips (the places where a gifted kid is merely average instead of outstanding) can indeed indicate a real and treatable problem.

Since you're seeking a second opinion, it's a good chance to revisit this explicitly. I'd ask specific questions about this in the consultation if you go that route.

DeeDee

DS did great on the new med dosage! I'm keeping my fingers crossed that tomorrow will be another good day. He even went to piano and counseling after school. We didn't get home until 6:30. He ate dinner, and then did his homework at 7:15. He finished his homework in less than a half hour and didn't complain once.

He had to write sentences with his spelling words. Usually, he tries to think of the shortest sentences he can so he doesn't have to write so much. Tonight, he was adding to the sentences to make them more interesting and working at a very good pace. After homework, he went to bed, we read a few pages of Harry Potter, and he was off to sleep. Not one meltdown all day!

He absolutely loved his after-school piano lesson and was focused the whole time. The counseling session went well. It was our first one, and I think we accomplished a decent amount in just one session. It's definitely a work in progress, but it's a good feeling to have such a positive day.

I was concerned that the increased dosage of his stimulant would exacerbate the anxiety or make him emotional. That didn't happen at all. And, I am very relieved that it didn't affect his personality. He was calmer but still had a good bit of energy, was not lethargic or tired, and was his normal happy self.

Our family, including ds, needed a really positive day, and we are very grateful. I might even sleep tonight. ; )