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

These are good ideas.. I will try this ... I bet we could turn this into a game and both of my kids would get a kick out of it. I wonder if this sort of "practice" really would help...

Just incidentally, I was just googling adhd and working memory and such and came across this board http://www.addforums.com/forums/showthread.php?t=125048 with adults talking about their adhd, how it affects their memory and the effect their meds have on working memory... It's just a board but I find it interesting...

Anyway, after reading all of your thoughts I think I definitely need to at least explore the ADHD angle - I need to look at everything. Clearly, I don't know enough. I don't want to turn my back on something and have that be THE THING I should have looked into to help!

Oh and also just as an aside.... other than the working memory stuff, the school eval was glowing about my DS! It talked about how engaging he is, what a great sense of humor he has, how he works hard when necessary and, yeah, how well he attends (LOL not kidding) and concentrates, etc. They called him "delightful." and pointed out his "excellent fluid reasoning skills" as well as his strong quantitative reasoning and knowledge, that he is able to recognize higher level connections, that he has a great voca, etc... Oh and discussed his creativity and imagination.

It was really nice to read - other than his poor working memory stuff . The last report was really rather unflattering - quite upsetting actually. So this was nice in that respect.

I'm obviously not a psych either, but my son has adhd and we've seen several doctors and therapists. I have been told that in some kids their ability to pay attention and concentrate may seem fine, but you'll see the adhd in their in ability to control their impulses and consider consequences of their actions. That is what we see with our son. He can (after much complaining) read a boring book and do boring schoolwork, but without meds he'll literally get up in the middle of doing things because a thought popped into his head.

I would encourage you to do more reading on adhd. There are lots of non stimulant meds now with fewer side effects.

You're right that I don't know who to believe. The vision therapist has a reputation about 50/50 for working or not and he was fairly aggressive in his contract. I don't completely trust the opinion of the pediatric opthalmologist because when DD went for a follow-up I saw that during the "dots" test there were a different number of dots DD was looking at than she reported. I pointed this out and the dr. shrugged and said it was good enough, that her vision wasn't perfect but if she was getting good grades at school it's not really a problem. The issues are 1) she's capable of much more advanced work so that argument isn't satisfactory 2) she completes her schoolwork and homework (output) with a level of frustration to cause notice of teachers at least enough of the time and at home also, to be a matter of concern, so this is also not satisfactory.

I told the pediatrician and asked his opinion about getting a 3rd opinion and he said "I wouldn't bother" stating that were I was at this point is a common place to be between these two camps of eye professionals.

Meanwhile hopefully this will be an issue covered in a neuropsych exam or if not I have the name of another vision therapist with a better reputation a little distance away but if we decide to do therapy there this spring/summer will make the drive easier.

Anyway, thanks for your message!

It's so hard. I was vacillating between surgery and therapy - those are the options for my DS. As you may be able to tell, I kind of like to be able to "fix" things, right? I just want his vision "fixed" - I don't care if it's "out there "light therapy or vision exercises or surgery or whatever - it doesn't matter to me if it is homeopathic or mainstream. Of course, this problem is much more complicated. I would love to just get him surgery but the surgery's success rate for his particular condition is pretty low. So, I think I'll just find the best surgeon, right? Well my neighbor's kid has the same type of vision problem (except her child's intermittently drifted out instead of crossing in) and they seem to think vision therapy is total quackery. They went to the best surgeon in the area (her husband is a doctor) and got their girl the surgery. That poor child's eye now crosses in. Last I talked to her mom, she told me that the surgeon said she would grow out of that. But both my husband and I saw the child last week and her eye didn't look good at all (I noticed it crosses in more in the morning - and is better in the afternoon). She had the surgery a year ago and her eye looks way worse. Also, my son said she s really behind in reading and he attributes it to her eye problems becasue he said he had a much harder time reading before vision therapy too. I have no idea of course but I suspect the vision is playing a big part. My husband and I have stopped considering surgery at all now. I have yet to read or see a success story with the surgery. Originally surgeons were telling my neighbor that nothing could be done b/c those surgeons wouldn't even consider VT and the surgery itself just has such a low success rate.

The VT on the other hand has helped trmemendously but my kid still isn't "fixed." He's still symptomatic... and it is frustrating. However, he is significantly better and fortunately he likes the in-office therapy at least. I am just getting impatioent for him to be "cured" you know...Guess I need to work on adjusting that expectation

marytheres, I'm glad DeeDee mentioned this (which is a great idea!)... because it reminded me of something from the years when my dd was younger and we didn't realize she had vision issues. We were *extremely* worried about her ability to remember simple directions -we would ask her to go to another room and bring back something - very simple directions that her two-years younger sister could easily do- and she'd completely forget, get distracted so easily. This was all happening before we'd been to see a neuropsych for ds, so I wasn't familiar with terms like working memory back then, but today I'd describe what was going on as appearing to be challenges with short term and working memory. But really - it wasn't! The things that looked like memory issues improved tremendously after improvements from VT started kicking in. Her eye dr says it is a combination of visual distractions plus the combined load of effort required to process visual information is overwhelming the resources available to the child to integrate visual plus auditory systems etc.

polarbear

But this is what none of us even teachers are seeing in my DS - he actually has good impulse control - not borderline in any way. He can wait his turn, wait to speak, etc., etc. And he does stop to consider consequences, etc. He doesn't “get up in the middle of doing things because a thought popped into his head" - none of that.

I just asked him to go upstairs get the glasses for his vision therapy and the paper ruler (ruler that measures his distance from the screen), grab me a tissue and come back downstairs... He did it all quickly, he did not seem to get distracted (to me) but he forgot the ruler... This is common with him but it doesn't seem to be that he got distracted and forgot - he did all on task but he simply couldn't hold all of that in his head ... like there simply wasn't enough 'room'. He's not like the one poster whose kid was told to brush his teeth and ended up in the shower. But if you give my DS three things to do, he'll usually stay on task but still forget one. He also cannot multi-task AT ALL. Like, he can't talk and put on his shoes - he doesn't seem to get distracted but he simply cannot do both at the same time. When he gets into school he cannot chat with his friends and get his stuff together at the same time. Not sure if that is 'adhd' in nature (I didn't think so but I really don't know) but that is what I feel like I see. I see that it isn't that he can't concentrate, is so easily distracted or control impulses or any of that - I see him being unable literally to keep things in his head at the same time - not due to distraction, inability to control impulses or due to inattention but almost as if there simply isn’t enough "room."
But maybe that is a type or a manifestation of adhd... I didn't think it was but I don't really know I just assumed that is why it doesn't really come up.

He is very fidgety and uncomfortable due to hypotonic... I think that affects this stuff. Like he needs to spend so much energy and concentration holding his posture due to poor muscle tone in that area and holding his pencil that that takes up some of his "working memory" space.

I think it's odd, that his eval report says he scored above average for the digit forward but simply can't do the digit backwards... He scored in the 84 percentile forward but 7 in reversed digit test

I don’t know. There is only so much I can speculate but I can use the info you give t explore this with the doctors. I called the school psych again and left a message saying I'd like her thoughts on ADHD too when we speak or meet. Hopefully, she'll call me on Monday. I can also take all of this to a neuropsych and see what test he/she could do to determine if it is adhd in nature or something else.

The psych hit the nail on the head in her report when she writes that DS has "...appropriate ability to inhibit impulsive responses, adjust to changes in routine and task demands, modulate emotions, initiate problem solving, plan and organize problem solving approaches and monitor his own behavior. However, {DS} does have difficulty holding an appropriate amount of information in active memory for further processing and/or mental manipulation."

The mystery is "why?"

Oh and can I just say - this kid has had tons of OT for years now and on the Bender Gesalt test he scored n the 5th percentile!

Yes, I think this is/could be a factor.... Processing issues eating up mental ram so to speak! I am still trying to compare the two test results (last year's WISC before VT and knowledge of vision issue) and January's SB-V after 6 months of VT. But the tests are different so it's not as easy/clear. as I would like. However, DH and I went through it last night and DS has improved. On the Wisc he was like in the 'well-below borderline range' (the eval uses the word "retarded" to describe the range but I hate that word) for processing, working memory and visual spatial (they actually had to throw the VS test out last year b/c he got none right and simply couldn't do the test) now on the corresponding SB-V subtest he is "low average" on WM, Processing and I visual-spatial... We did the comparison in attempt to help me to stop freaking out LOL and it did help. He has actually improved decently since starting VT - it's just slow and he is still low ... So, there's that. I did talk with his vision doc and he said the same as you... he said they could also inocrporate some Working Memory stuff in to the therapy...