Gifted Issues Discussion homepage Forums Twice Exceptional Working memory/executive function - how fix? Help!

He does OT for hypotonia but not for any working memeory/executive function issues. Let me ask you this - do the meds your son is on specifically help him do remember muti-tasks and remember sequences? My guy isn't running around hyper-active, he doesn't have impulse control problems, he focuses well, he is mostly very attentive... He has problems "remembering" things, especially remembering sequences - he can't tie his shoes (because he can't get the sequence aspect of it down), he can't remember left from right, if I tell him to do three things - he may forget one but mostly what he has problems with is if he is suppose to do the things in an order, ykim? Do meds help that? For example, if he were really add/adhd and he got meds would he be able to the digit span test backwards?

If I were to put him on meds (and I am not a doc so obviously I can't just try it on my onw but I totally feel like I could shop around for a doc or even persuade his pediatrician to try him on adhd/add meds) and he were truly add/adhd would I see that stuff immediately improve like a "light switch"(given the right med, dosage and that he is really add/adhd)? Because if so, it may be worth a shot really. I don't want to turn my back on something that really could help, ykim? Even if I am skeptical that is the true problem.

I could ask where he gets his OT for hypotonia if the do OT for working memory/executive function... I know they offer like a group class thing for it (but you have to 8 or 9 to take it - he's not old eneough for it yet)

my DD has never been on meds but we know plenty of ADHD friends - they are fun kids! - and I honestly don't know any of them as having an immediate fix. Either they need a different type, different dose, or something else to counteract side effects, like lack of sleep. But others who have direct experience might be able to better answer.

I am going to talk tomorrow to his private OT about doing OT for it and seeing if that helps! I looked on their website and it said they do OT for ADD/ADHD so it looks like they could help. Good Idea CCN! At least I feel like we can try something to address/help! I am also going to ask if his school OT could help with it as well - after all, the info on his poor working memory and executive function issues are all laid out in his school psych report... we'll see. I mentioned it to his vision doctor and he said he could work some working memory into his vision therapy (that surprised me, actually)

By the way, Bzylazy, I wanted to comment on this. Today my son did he three month eval with his vision doc and they give him all kinds of tests to see if the VT is helping, where he is still struggling, etc. Anyway, he did a near point test and again I could "see" my son's eye cross and then his eyes physically and obviously became very irritated during the test. Seeing this means to me that no other doctor could tell me my kid doesn't have intermittent convergent strabismis. I literally saw his left eye quickly cross in while his right eye stayed straight... when this happened his eyes became red and irritated looking, then started watering as he tried to continue the exercise but the left eye crossed in a few times and caused him more irritation, fatigue and inability to keep his eyes working (basically he couldn't keep them following a target together - he physically struggled to get them physcially focused.) I don't know what type of convergence issue your daughter has but maybe seeing her do some of the tests could help you feel more sure in one of the doctor's opinions/diagnosis. Just a thought as it sounds like you don't know what/who to believe.

Do you know about the difference between the different types of ADHD? There is something called ADHD predominantly inattentive type, which is different from the stereotype.

It can cause memory issues, problems with sequencing tasks, and executive function glitches.

I would not under any circumstances just doctor-shop and try meds. I'd get someone who really knows what they're doing to evaluate for ADHD-- a neuropsych can do a battery of tests where the pattern of glitches will reveal ADHD if it is there.


I should warn that in our experience OTs claim to be able to fix many things that they cannot fix. (I realize that others' mileage will vary.) Nothing an OT has done has ever improved our kids' ability to function in that regard.

For younger kids (1st-2nd grade, say), the only thing that is proven to work on ADHD is meds; as they get older you can do more and more behavior training and coaching on workarounds so that they learn to manage themselves. But again, I would not attempt to diagnose this, nor would I let the general pediatrician prescribe this kind of medication for my kid.

HTH
DeeDee

Yes, but, of course, it's not like I am super knowledgeable in this area. However, my undertsanding of that type is that such children may appear to be underactive, daydreamers, etc...instead of working on their math, they might be gazing into space. When the teacher calls on them, they may have no idea of what is being discussed and that they don't absorb new information well - basically they have difficulty concentrating. And the problem is my DS concentrates and attends very well, he doesn't lose track of or ever have any trouble following a discussion (seriously EVER) (in fact he constantly gets high grades and much praise for contributing to class discussion and "attending" to what is being discussed in class. He can remember discussions, books read to him, etc... He learns new info fast and well.

I even asked his teacher who has a son with those of adhd and she said she doesn't see it either (though she sees workingmemory issues - he has no trouble staying on task in his classwork, staying completely in target in discussions, etc). BUT she is not a doctor (and in the past some teachers have hinted he has had it - we actually have two for two LOL).

I know I am not even close to an expert on this or a doctor, but I feel like the hallmarks of both types are ATTENTION (after all that is in both of the names (Attention Deficit and Inattentive type )and that just isn't the problem with my DS. I guess I feel like it's not that DS has working memory problems because he is having trouble concentrating or attending - he can't remember and process certain tasks/info no matter how hard he is concentrating/attending and despite concentrating and attending. And, again, this is just my understanding and maybe it's a misunderstanding; but, my understanding is that the ADHD spectrum is WM/executive functioning difficulties basically stemming from an inability to concentrate, to attend, to focus... my son can focus and attend and concnetrate well but still, and despite that, has active memory 'holes.' My sadness and fear is that the meds won't help his memory - and he simply doesn't need help focusing or attending. He actually does that well. I am not sure if this is valid understandng or not.

These are some things I read about working memory deficits that really resonate with me. First, they are "children who have trouble with activities that require both storage (remembering) and processing (manipulating information)." THIS is totally my DS no matter how well he is concentrating - if he has to do both he can't and not becasue he gets distracted or can't focus. He simply can't do both - ykwim?

And this:

"Researchers estimate that about 10-15% of school kids have working memory problems, but these are often misidentified as deficits of attention or intelligence (Holmes et al 2009)."

I don't know ... I guess I need to first talk to the school psych about this and see what she says about all of this. I am jumping way ahead and I really need to hear her thoughts. She observed him A LOT five days of testing and observed him in his class a number of times. She must have some good insight and thoughts on ADD/ADHD. (I just am slightly mistrustful of school psychs )I also think I need to just go talk to a neuropsych. I am looking for him to get a WISC IV test anyway so I can see exactly what has happened with his working memory and processing over this past year via comparing WISC tests (did it stay the same, did it improve somewhat even though it is still low, etc) Neuropsych should be even better with the nuances of the Adhd tyes and manifestations, right?

The whole concept of a "fix" is something you may need to make some adjustment on... 2E kids can rarely be "fixed". It is a very long haul to help them both shore up their weaknesses and help them delve deeply into their areas of strength. I doubt any one professional is going to get you the one answer you need. You are likely to go through a lot of starts & detours, and maybe even conflicting diagnosis and advice over the next several years. Being steady for your kid is pretty important during this process.

Yeah so very true ... hard for me but true.

Bummer. Thanks for the warning, though. I'll takj to them and while keeping your experience in mind - he's there for hypotonia anyway so ...