Gifted Issues Discussion homepage Forums Twice Exceptional Is it ADHD or Dyslexia or Both?

My DS, 8, is having a tough time in school, and his teacher has recommend a 504 plan to help with his inattentiveness.

DS is in 3rd grade and reads well above grade level, grasps math concepts easily and does very well socially. He does not have behavioral problems. His handwriting, writing skills and spelling are all below grade level and he makes multiple, carless mistakes. His teacher suggested that I have his vision checked. I took him to a Developmental Optometrist. HIs acuity and tracking are fine and I am waiting to hear about the rest of the test.

DS had a severe language delay and was in speech therapy for 2 years. He has been in-and-out of OT for years. He was diagnosed by a neuropsych with ADHD but with the caveat that he looks like he has severe sensory issues. At this time I realized that he was not sleeping well. Melatonin was recommended by his dr and most of his obvious sensory problems cleared up 2 weeks after starting melatonin. He was discharged from OT and I was told that he is so smart that he must be bored in school and that he is fine.

I saw the Eide's slideshow about stealth dyslexia and think this may be what my son has. He can't learn to tie his shoes, he is clumsy yet very fast and strong, he did not learn the ABC's until he was 6, writing is a chore for him and he is not able to organize his thoughts to write them down. Although he is an advanced reader, he skips/inserts words when he reads and often reads short directions incorrectly. He also tests very poorly on computerized tests. His teacher said that he would do great if his tests were all oral.

DS 8 tested as gifted on the WISC but has a very slow processing speed. His tester is very experienced with GT kids and felt he was ADHD or had a sensory issue.

I think the 504 may be a good idea but am concerned that the school is only considering that his struggles are due to ADHD (inattentive) and have not considered that he may have an LD. I could use some advice about where to have him evaluated for an LD. My gut feeling is that ADHD does not explain all of his struggles. I would really appreciate your thoughts.

Hi cct,
I have a 2-E child with severe dyslexia/ADHD & dysgraphia and a fairly typical child with attention weaknesses. Based on your description, I think you are wise to wonder about dyslexia in addition to the add - they often come as a package and certainly affect the academic areas you have mentioned.

Is your child in a public school? If so, if you make a written referral requesting a full evaluation in all areas of concern (attention, spelling, motor and even speech and language) the district MUST fully evaluate in all areas in about 60 days per IDEA, federal special ed law. Texas is one state that actually recognizes dyslexia (most only recognize specific learning disability in the area of reading and or writing), so hopefully they have good evaluators on staff. Once the evaluation is complete, you should get a report and meet with a team of educators and evaluators to discuss the results, determine special ed eligibity and if eligible, write an IEP (individual education program) that addresses all his needs. If not eligible, you could then ask for an independent evaluation using an expert outside the district for a second opinion. You also have the option to go to the 504 team to see about getting accommodations.

If your child is in a private school, you still have a right to ask for the testing from your public school district and it is possible that you could arrange for services at the public school - although scheduling can be tricky.

You ask where to have him evaluated. Generally, an outside evaluation done by a private neuropsychologist will give you more complete data and comprehensive recommendations. Private evaluations tend to be more diagnostic in nature. However, public schools are only obligated by the law to consider the results of the evaluation - not accept and implement them. School evaluations vary - but if you hope to get school services, most districts will do their own testing, even if you have recent and comprehensive private testing.

If there are LD schools in your area, they most likely maintain a list of good evaluators that specialize in children with learning disabilities and are able to write reports that can be implemented by schools. In my area the cost for a private evaluation ranges from $2500 to 3200. I prefer evaluators that conduct the testing over 2 to 3 settings and that will come to school meetings if needed.

Other sources of evaluators are testing centers within colleges and universities that specialize in education and or children's hospitals. If you go this route, find out who actually will be conducting the testing and who will be writing the report. THere is important qualitative data to be gleaned from the test administration and I prefer that the "tester" and writer be the same person!

You didn't mention whether or not you are treating the ADHD. This may be something to consider, too. While it most likely is not the entire issue, ADHD can have global effects that impact many areas of learning -especially as the pace quickens and kids are tested for precision as well as overall understanding. Things like vigorous exercise and motor breaks can help as can medicine if it can be tolerated. (you might enjoy the book "Spark" by John Ratey)

Oh - one last thing - as far as the sleeping - make sure you rule out interference from large tonsils or adenoids. Poor sleeping CAN be an ADHD look-alike.

Just ran across this article and thought of this thread. Hope it helps you sort out what is going on:

Is It Really ADHD? Or Could Your Child Have a Learning Disability?
Your child was diagnosed with attention deficit disorder, and is taking ADHD medication, but he's still struggling at school. Could a learning disability be to blame? Learn the warning signs, and what parents can do to help.
by Larry Silver, M.D.
http://www.additudemag.com/adhd/article/3270.html

Have you ever thought about videotaping your child whilst doing homework? We did that and discovered that the inattentive that we were told was ADD was actually focal seizues! She still has dyslexia issues, but her attentiveness has changed dramatically!

I believe my son has stealth dyslexia. His reading is off the charts (behavioral optometrist says grade 12), but he has problems with organization and still reverses his letters once in awhile (he's 8 today!). He also has CAPD, which doesn't help with attention in a classroom situation.

What I did was to revamp his diet- he's gluten free now and the results are spectacular. Hes so much calmer now and can finally sleep 8-10 hours a night. He also eats better too. For his visual processing, we do a lot of physical exercises and ball sports, as well as mazes, dot to dots, which help in hand to eye co ordination tasks.

Is you son a very visual spatial learner? I found that part of his reversals was because he liked to "twirl" images in his head. Helping him identify laterality or left-rightness worked in my son's case.

Thanks for your comments. I now think my son has a Visual Processing Disorder. The descriptions of a few of the sub-sections are right on for him:

http://www.ldonline.org/article/Visual_Processing_Disorders%3A_In_Detail

and explains why I have heard so many times that he either has ADHD or or a severe sensory problem. Two years of OT did not help him very much because I know think the symptoms rather than the cause were being addressed. We are going to give vision therapy a try.

The testing by the behavioral optometrist revealed that he processes visually information very slowly (5%) and his WISC IV scores backs this up (GAI 99% with Processing Speed of 16%).

He struggles with writing, spelling and quick math computations. I am hoping for accommodations from the school and help with his writing. I am going to request that the school complete a full evaluation as well as have a private evaluation completed.

My husband thinks he struggled with these issues also, but the classroom was much less visually demanding 40 years ago.

cct - visual processing orders often accompany dyslexia. My son also has visual processing (and auditory processing) issues and he underwent an intensive VT program to target the visual issues.

The research about the long term benefits of VT are unclear. But, what is clear, is that if your child has a weakness in his phonological system (the most common cause of reading and spelling difficulties), VT alone will not help. It is very common for children with ld's to have a large spread between GAI and PSI and or WMI. My son's VCI and PRI are more than 45 points higher than his processing speed. Vision therapy and occupational therapy have not helped to close the gap.

I am glad that you are going ahead with the school and private evaluations in addition to the Vision therapy. This will insure that you are addressing all areas of need if there are in fact issues beyond the visual realm.

I hope it all goes well for you and your son. Please keep us posted.

I'm the original poster for this topic and this is where I am now. After my son's starting VT (his handwriting already is much improved!), I went to the school with my concerns about my son possibly having an LD. After talking about attention for awhile and listening to the teacher who said several times that he does not test well, that conventional tests do not show what he knows, and that, while he is above-average in his math abilities, he did poorly on a math benchmark, the school counselor and psychologist completely dismissed my concerns about an LD. The psychologist said that while the 45 point spread on the WISC IV between processing speed and the other parts of the test was an indication of a problem, she had no idea what it could mean and did not suggest testing. I have not requested a formal evaluation from the school at this time but imagine that will happen soon.

I then went back to my son's neuropsychologist who looked at his writing samples and his grades and listened to my description of his difficulties. The Dr. said that he looks like he is 2e and that he is likely dysgraphic and dyslexic. He added that there is a huge achievement gap and that my son should be able to easily complete work several years advanced and that his struggling in 3rd grade is very worrisome. The Dr. was adamant that my son's difficulties could not be solely explained by ADHD as the school has implied many times. My son will go in a few days for testing for dyslexia and dysgraphia and another look at the role ADHD may play in this. The Dr. did add that the dyslexia is likely a vision based dyslexia. I am not sure what that means.

Any advice?

I agree that your DS may be a stealth dyslexic but I would be wary of the "vision based dyslexia" label. As Mich mentioned above, VT alone will not help. My DD finished her VT in the fall and so far the benefits are holding. Her tracking and focusing ability have improved and the headaches are gone.

VT hasn't changed how her brain functions. If you haven't, you may want to check out the Sally Shaywitz book "Overcoming Dyslexia." It has fMRI results showing differences in the way the dyslexic brain functions. When DD is well rested and emotionally happy, she compensates so well that it is easy to think that the problem is not that bad. When she is upset, tired or sick, it all comes out. I can even tell when she is getting sick by the subtle changes in her out loud reading.

I think that it is time for you to request a full evaluation from the school in writing. Even then, they may miss it. You may want to consider an evaluation by the Eides if you can afford it.

Well - Here is an update and I am more confused than ever! I have a diagnosis for my son of Dyslexia, Dysgraphia and ADHD from a psychologist and of CAPD and SLI (Specific Language Impairment - is this the same as dyslexia?) from a Speech Language Pathologist.

The psychologist called the reading problems mild and the dysgraphia severe.

The SPL states that early speech therapy addressed phonological deficits which may account for DS 8's strong reading skills but that he has pervasive deficits of morphology, semantics and language pragmatics. He is very slow to respond orally and retrieve words. The SPL has recommended speech-language therapy.

DS 8 scored in the superior range on the Gray Oral Reading Test and well on the TOWRE. For a dyslexic child with this type of profile, is an Orton-Gillingham based reading method (like the Wilson Reading method) the correct approach?

The school is administering the CCTOP and has called a 504 meeting, but I have been told by the school that he will likely not qualify for the dyslexia program but will qualify for a 504 for an LD in Written Expression and Comprehension.

His pediatrician is reluctant to prescribes meds for the ADHD because of his sleep issues (caused by his tongue being too large - not his tonsils) and because she thinks the school needs to provide services and accommodations prior to trying meds.

My concern is that the school will only offer accommodations and not services for a child who is showing up to a 3 standard deviation spread between ability and achievement. Does anyone have any advice?

Thanks!

What were the scores on the TOWRE for pseudo word decoding and word reading? If the pseudo was significantly lower than word reading, this could indicate that he does not have a solid foundation of the decoding rules and word patterns and Wilson might be a good program. On the GORT, how was his accuracy vs speed? It will be interesting to see the results of the CTOPP and will give you additional info as to whether or not he needs to improve his phonological awareness skills and decoding skills or not. Also - how did he do on spelling? Often, poor spelling is a good indicator as to whether or not a child has a solid knowledge of the sound symbol relationship, word patterns and rules.

As far as the dysgraphia, what are the main issues? handwriting, written expressive language, spelling? What are the recommendations?

As far as the CAPD, virtually anyone with dyslexia has some aspect of CAPD. Often it is the inability to perceive all parts of a word, to hear the small differences between sounds, to be able to rapidly process sound or bits of language. Here are two resources that you may find helpful
http://kidshealth.org/parent/medical/ears/central_auditory.html
http://ocslha.com/Ferre.htm

As far as whether he needs a 504 or an IEP. A school is more reluctant to give an IEP because it comes with more procedural safeguards that protect the student. (more teeth so that the parents can monitor whether or not it is being implemented) An IEP also means that the student requires specialized instruction or related services in order to make progress.

Without knowing more about your child's difficulties in school and test scores, it is doubtful that a child that tests in the superior range on measures of reading will qualify for specialized instruction in that area. But, you say that he has a 3 standard deviation spread between ability and achievement. Perhaps this is in writing? If so, I believe you would have a case for services. Be sure that you bring work samples to the meeting - especially samples of INDEPENDENT work. If the SLP recommend S&L therapy, this would also be covered in an IEP. Often times students with oral expression difficulties such as word finding and formation also have difficulty with written expression. (if you can't say it, you can't write it). Often the SLP will work with the writing specialist to help.

Given his very slow processing and ADHD, he may need help with executive functioning skills. Sometimes kids with an IEP also have a study skills or academic support goal to help them learn to be a more active and efficient learner.

If he needs this kind of support, and IEP would be the best bet.

Based on the CCTOP the school says he does not meet the school's definition for dyslexia. I think we are headed for a 504 with modifications and no services unless he qualifies for a Tier II reading group. I can ask for an assessment under Special Ed., but I have heard that his school's special ed program does not serve 2e children very well. They don't seem to know what to do with them.

The dysgraphia is where he has the large discrepancies. His handwriting is terrible and he struggles with output. I have been working with him at home at composing on the computer and he is doing better. The Speech Pathologist says that an underlying weakness in his language skills are the problem as well as slow word retrieval. He had severely delayed language acquisition followed by an articulation disorder.

He is starting speech language therapy and Interactive Metronome has been recommended. Any comments about IM?

TOWRE Sight Word Efficiencies: 65 words in 45 seconds; score of 113(80%)
TOWRE Phonemic Decoding: read 32 pseudo words in 45 seconds; 73%; high average

GORT: Accuracy score 14; 91% and Fluency score 13; 84%

CCTOP: Phonological Awareness: 104 or 73%
Phonological Memory: 103 or 58% (scored 25% in nonword repetition - could this be indicative of the CAPD)
Rapid Naming: 103 or 58%

These scores are pretty solid. It's hard to make the case that he has a reading disability when his reading scores are mostly in the upper quartile. His CTOPP scores, which are the underlying reading skills are not as high - mostly dead average seem to be a solid foundation for day to day reading. It would be interesting to see the CTOPP subtest scores in addition to the index scores that you posted. Sometimes there is a lot of scatter within an index that could indicate areas of concern. (such as nonword repetition - although still in the lower end of average).

It is heartening that his rapid naming scores are so solid. Often, kids with retrieval issues have trouble in this area, and this results in poor reading fluency. But, your child seems to have decent skills in this area.

So - as far as needing an IEP for reading - these scores do not support this. Not sure if there are issues with comprehension - this would be an additional area to consider. It sounds like writing is the real issue, and it will be important to tease out what are the contributing factors: handwriting, language retrieval and formulation, attention, organization all or any of the above.

I have no personal experience with IM - but have heard of others with similar profiles that found it helpful.