Gifted Issues Discussion homepage Forums Twice Exceptional I need guidance

I'm a long time lurker (even before I signed up), first time poster. I apologize in advance for the length.

My dd is 8 and in second grade, dx'd in 11/13 with adjustment d/o (more anxiety). Started her on Prozac which helped her daily crying at school, but didn't help her behavior at school. Academically, she's been strong, but honestly, I don't think she's been challenged since she started school. I was finally ready to admit she had impulsiveness and hyperactivity a few months later, and in 2/14 we started Concerta. It was my *duh!* moment.

Another health issue my dd deals with is precocious puberty. It was caught last yr at age 6, which was about when her behavior deteriorated in school. I noticed a lot of inattention at home over last summer. The treatment only really helps to slow down the process of puberty. Her endo thinks most of what we are seeing in regards to mental health is the effects of estrogen on a young brain. she is no where near ready to start puberty. I'm not ready for that, either, lol.

I've gone back and forth on the "is she gifted?" issue. I do think she is in some realms (language, reading, creativity, history), and maybe average to above average in others (maths, science). I think it's mostly interest driven. You can show her a picture of a president, and she knows first, middle, and last name. She also knows most of the first ladies, along with random information she's read. I'm a history idiot. She remembers things she's learned once, makes connections on her own, and has a large vocabulary.

On the other hand, I've met some very obviously gifted children, and I have my doubts she is above moderately gifted. I do not care either way, and up until recently, I've just supplemented her craving for learning at home.

Now I'm wondering if the possible giftedness (as well as her adhd/anxiety) is affecting her inability to make friends and keep them. She was crying to me the other night that she has no friends. Unfortunately, her wonderful school last year was a victim to budget cuts and was closed. She's at a new school this year. She does know some kids at this school from last year, and I volunteer as much as I can on my days off from work (I'm a single mom and work full time). I did have an assessment done in 12/13, but she was having a good day that day. He did see some impulsiveness, but he said dd was by far not the most disruptive in class. Not very helpful, in my opinion. I've had her diagnosed via private doctor b/c I know how tight $$ is in our district, and I'm not about to depend on them for a diagnosis. I am in the process of getting dd a 504.

I'm having a hard time determining why dd isn't making friends. There are some mean (angry and sad) kids in her class, but I know dd overreacts when she is overstimulated (we have an OT who has put together a sensory diet for dd...unfortunately, most of the calming things are less possible in a school setting. she verbalizes that she wants to make friends, and she seems perfectly happy with just having one or 2. She's gotten into a pattern of having one friend she is hot and cold with (different child this year from last year). I suspect sometimes dd misreads other children's intentions, overreacts and turns the other children off. Many kids have called her a cry baby from when she was crying daily in the beginning of the school year. Now she reacts more with anger, but it still has the same isolating effect. She does do better one on one.

I'm just trying to figure out the road map. I am taking a new job with better insurance, so I intend to get on a waiting list for a neuropsych. I'd like to have a second opinion on dd's dx's as well as an inventory of her strengths and weaknesses. I'm worried what an increase in workload will do to her. She's very unorganized, and I have to work very hard to keep everything consistent. It doesn't help that her dad and I are divorced, but we get along very well.

She's seen a therapist on the past, and we have an appt in a week and half to start again. She's mostly a talk therapist, and we tried her before the Concerta, but despite "knowing" what dd should do, she just couldn't "do" it, if that makes sense. Perhaps now she has better self control and can implement learned strategies now. What kind of therapy has worked for your kids in the past?

What else should I be doing? I have her signed up to be tested for gifted, but the guidance counselor seems very young and overwhelmed. They use the kbit 2 to screen, and from what i've read, it's a very brief test. If dd is in a mood, I can easily see how that will affect the test results. I certainly do not want to have her be part of a program that is too advanced for her, but I do wonder if a lack of peers is contributing to her problem. She gets very annoyed/frustrated by her same-age mates. She tends to play with older girls, or like a big sister to younger girls. I wish she came with a manual.

Sorry this is so disorganized. Despite the fact my dd was adopted, she and I share the diagnoses of anxiety and adhd. i've been reassured that i didn't "give" her adhd...but i'm sure my anxiety has an effect on her.

Have you observed her in a group of kids? That might give you a better idea of what is going on.

DD is the same age (but grade 3) and hasn't had a hard time making friends, but in second grade in particular there was a lot of drama with the kids (esp. girls). This year she is either in a very nice class, or the kids are all just a bit more mature. She was also on Concerta last year and then Adderall and both of them made her moody as they started to wear off (which seemed to be the middle of the day). Adderall in particular made her kind of a basket case. She does much better with her mood and getting along with people on Daytrana. When she is not medicated at all the other kids tend to irritate her (and/or overstimulate her) a lot which can cause her to lash out. Not great in terms of making/keeping friends although she has always been so social I suspect she would always have friends anyway. If anxiety is combined with ADHD, it could potentially cause a lot more social problems.

Thanks for your response.

Dd does better one on one or in smaller groups. I think it's a mix of sensory and anxiety in the classroom or larger groups. She likes playing with other kids, until there is some sort of disagreement. She either misinterpretes other kids, or she she is very easily annoyed by them (this has been present since before starting meds). I try to spy when I can, but she seemed worse when I volunteered in her classroom earlier in the year.

I'm praying for dd to mature some over the summer. I just wish I knew how to help her.

My DD is 8 and also has ADHD and a lot of anxiety. She tends to have a lot of "friends" even though she doesn't have very good social skills, which I really don't understand at all. Kids either love her or hate her. But with other kids she tends to be very bossy and she isn't very flexible in her play: she really only wants to play what she likes, doesn't want to try new things very often. When we had her last big eval, they thought she simply impulsive enough that she doesn't think enough about what she says, or pay enough attention to what others are saying/doing to properly interpret their behavior. She's really just in her own head much of the time.

Have you tried talking to the teacher about the friend situation? I've found the teacher often has a good insight into social issues within the class. DD also attends a social skills "class" with the special ed teacher several times a week.

I think I would also push the school to recognize and help remediate disorganization at school. If she has a medical diagnosis this might link to, then I would push for accomodations in her 504, or even consider an IEP. DD gets aide time once a week to help her organize her desk and her papers; I really think she should get this every day, but thankfully, she doesn't really have much in the way of homework or anything yet.

It sounds like your dd has three diagnoses that the school may respond to with at least a 504. The ADHD and anxiety Dxs both have implications for organization and social skills, and would warrant a 504 in most settings.

In a larger group of children, she may be having difficulty attending to and reading all of the social cues (factors associated with both ADHD and anxiety), which can be very frustrating. In a 1:1 or small group, there isn't as much data flying around that she has to capture, interpret, and organize, and then manage impulsivity to execute the appropriate response. I imagine she finds it quite exhausting to put all of this together in a larger group of children.

Adults naturally scaffold and structure for children, so it's much easier to interact socially with adults. It's possible that when she knows you are present, she unconsciously expects you to do more scaffolding for her.

What might be helpful for her is to talk through and role-play some skills for reading others emotions, and dealing with common interpersonal conflicts that come up between kids. Practice them in a nonlive setting first, then in sheltered live settings (such as with a sibling or a one-on-one playdate), with coaching and cueing in real-time, and then a (private) balanced review of how the skills were executed or could be improved, and how the situation turned out, after the incident. If this is with a sibling or very understanding peer, (you have to be pretty careful here) it can be helpful to get feedback from the other child as well (you'll have to coach the other child before you start doing this, as well as through the live process, so they are not too brutally honest).

Once she becomes comfortable with the process to this point, you can start asking her to tell you how she was able to apply it independently, and reinforcing her when you observe her applying any part of it independently. I wouldn't work on more than one skill at a time.

An excellent resource for this is Ellen McGinnis's "Skillstreaming the Elementary School Child" (based on the research of the late Dr. Arnold Goldstein). It's designed for small group use, and is pretty much the standard for structured social skills groups in schools.

Thank you all so much! Some great thoughts I've been mulling over.

aeh-she IS exhausted after loud situations that involve a lot of children. She once fell asleep during a field trip, and this child is NEVER tired.

Aufilia-your description of your dd's interactions with friends sound very similar.

blackcat-many teachers, including dd's, have told me the same thing--drama in 2nd grade girls. i always stuck to having boys as friends as they seemed more predictable, so I feel very out of my comfort zone.

I tried like heck to get a 504 with accommodations. Dd qualified for one, but not with accommodations due to her grades (all "O's"). I told them I knew a child who is gifted with a 504 for anxiety. They said they recently changed the qualifications. Very circular reasoning, and I sat there for an hour. Finally they talked me into a behavioral plan with all of the same accommodations for which I was asking.

She did not qualify for gifted; her kbit 2 verbal was 127, but her nonverbal was 105. Is this normal?

The 'friend' issue is really always fascinating to me. I think I have insight to share, but it's hard to explain.

So, we have really analytical brains and great information to share, but it is very tricky sharing it with other people in our relationships. This is where I need to do some more research, but, it seems to me that many people do not really want to hear a gifted person's 'version' of the truth. To others, it sounds too harsh, even though, we are merely communicating.

In a work situation, though, our insights are invaluable, so you will find gifted people doing very well in difficult jobs and feeling very useful, working either for themselves or others, depending on how you view work.

Don't get hung up on having friends the way that other people have friends; by definition, it probably can't be the same. We are hyper-sensitive, so we know all of the cracks in any relationship anyway, so, in effect, that works against us - much harder to be 'starry eyed' for example, in a adult romantic relationship unless everything really is going very well.

When we are being overly-critical, we might be able to see the limitations of other people to seem to be our friends. It sort of stinks when their instincts are bad, so their advice is never as good. It is kind of like being in class and never having anyone to confer with on the answer because the gifted student is the best student in the class.

Very few people could probably stand our intensity level, so that is a huge limitation on the ordinary friendship.

Once you stop pining for friendships the way other people have them, you can focus on friendships that you can have the way gifted people have them. So, it is less about cliques and following the group and more about respect and trust and truly having something in common.

If you live in a crowded community, notice how neighbors swear their child found their very best friend close by in the neighborhood. Really what they do is restrict the child to finding who is close by because it is so easy for the parents.

For a gifted person in reality, we find our very best friends later in life as we go out and pursue our passions and find the other gifted people pursuing their passions. Turns out the best friend was not around the corner but in the world where we went to while pursuing our life. So, we have to wait to find our best friends.

I am not familiar with the scoring on the kbit, but the difference in nonverbal to verbal seems pretty wide. You might want to look into more intense testing privately if you can afford it. Sometimes large discrepancies indicate learning disorders.

This may be of some help: You should be able to get an IEP with the anxiety diagnosis. That's how my DS managed to get an IEP (over a 504 ), which is just stronger, more thorough, etc. He has a diagnosis of "generalized anxiety disorder." The anxiety disorder fell under something awful-sounding - "emotional disturbance." My husband was pretty upset at that "label" but I liked that it got him an iep as the 504 just wasn't working out to be a strong enough vehicle for him. At some point I think his category was changed to "other health impairment "(maybe once he was dx'ed with EDS, not sure). Anyway, I think maybe you need to push for an iep.

Also, sorry that she didn't qualify for gifted. sounds like she needs the gifted resources When you get her privately tested maybe the WISC (or Stanford Binet) would be a better test to show her giftedness and show where he deficits are. Will the school accept outside testing for the gifted program?

Social skills were very big issues for me (for different reasons - primarily the late diagnosis of my disability - all my IEPs that I found had a big emphasis on social skills). As a adult, I still find it hard to deal with large social settings especially if it involves a noisy environment.

Unfortunately for elementary school, I have no suggestions since those years for me were the years I struggled the most with social situations and making friends that I trusted - but one place where I found refuge in the latter part of my elementary school years was the barn - mostly because with horses and dogs, I never had to struggle with trying to figure out social nuances that came naturally to everyone else since animals don't care about that, and because the topic of horses would allow me to interact more naturally with others who had the same interests and not be constantly on guard or trying to decipher their body language, words etc. (as an adult, I have found similar refuge in a different sports environment - for similar reasons)

Is there something like that - an activity that she enjoys that she could spend time with others who have the same interest - that is away from those mean kids? That may allow her a place to just be herself, and then all the emphasis on social skill learning won't be so overwhelming.

If you are going to pursue an IEP anyway, I would suggest that you ask the school to evaluate her more comprehensively. You can cite both the existing anxiety and the significant difference between verbal and nonverbal on the KBIT.

Again, the KBIT is a screening instrument, so you can't put too much weight on the results, but I will mention that her test profile is very consistent with what you are reporting about her academic strengths and interests. The expectation for a student with strong verbal and average nonverbal would be that she would excel in language-related areas, like reading, writing, and history, and be average to high average in mathematics.

The social issues, anxiety, misperceptions, and hypersensitivity are also not unusual in kids with this kind of cognitive profile. Variously called right hemisphere LD or nonverbal LD, it is often associated with deficits in social perception, often comorbid or confused on differential diagnosis with ADHD, and often presents late, usually when abstract mathematics demands increase in late middle school or high school (or sometimes much later in a high cognitive child like your daughter). Sometimes there are physical coordination issues, too.

Every year I evaluate at least a few children who have either managed to get by until they reached the secondary level, or were on an IEP in elementary school, but dismissed at the beginning of middle school, before they hit the hard stuff. (In some individuals, there are early delays in reading, which resolve once decoding itself is mastered, and academic demands switch to comprehension. If this happens before math becomes abstract, they look like they're out of the woods, and are no longer eligible for an IEP.)

One caution about evaluators: not all evaluators (especially academic learning specialists; most psychologists will be fine) are familiar with NVLD/RHLD. I would suggest feeling out the school a little if you decide to try testing through the school, by experimentally bringing up NVLD as a concern of yours. If you get a blank look, find a private evaluator who knows about it.

Schools are not required to accept the recommendations of private evaluations, but they are required to consider the results.

Another route you can take is to have the district do the testing, then ask for an independent evaluation (at their expense), if you don't agree with the results of the testing, or believe that they are invalid for specific reasons. The district will have to approve your private evaluator (since they're paying for it), but there is no obvious reason they would object to a licensed professional with a legitimate practice or hospital affiliation. The other condition is that, since they are paying for it, they have a right to the results. So if you don't believe those results are representative of your child, you will not have the right to withhold them from the school.

Esmomma, you've received a lot of wonderful advice already - I have just a few thoughts to toss into the mix - sorry if they are in a bit of a random order, hope they make sense!


I believe that you are on the right path thinking of pursuing a neuropsych eval as soon as you have the insurance - I suspect it might be extremely helpful in teasing out whether or not there are underlying issues that are impacting situations, outside of merely social challenges. For instance, I would have written exactly the same thing you've mentioned here about my older dd at your dd's age - she seemed to have extreme anxiety surrounding loud situations that involve other children. When she was young we ran through a myriad of thinking re what the reason was, including both social anxiety and wondering if she had an issue with auditory processing - and her neuropsych revealed something we had completely *NOT* anticipated - she had a possible issue with vision. When she went through therapy to resolve the vision issues, the problems that had looked like anxiety disappeared. I'm not suggesting that your dd has a vision issue, just pointing out that until we had our children's neuropsych evals, it wasn't easy to understand what was at the root of the behaviors we were seeing in our children. The same was true for our dysgraphic ds - I had never heard of either developmental coordination disorder or dysgraphia before his neuropsych eval, but we landed with a referral for the neuropsych eval from our ped in 2nd grade due to extreme anxiety and challenging behaviors at school. What we thought was the primary issue (the anxiety) turned out to be secondary to, and caused by, a completely different developmental challenge.

And fwiw, it's so important to have the "big" picture and to really understand as much as you can what's at the root cause of the challenging behaviors - because if you don't get down to that level to remediate/accommodate - you aren't going to take away the challenge, and addressing the problem behaviors without that will only be like putting a temporary bandaid on the problem - a bandaid that's going to peel off with time, and your child will continue to struggle.


FWIW, drama doesn't necessarily fade with girls after 2nd grade. What I've found with my daughters (and with my ds' classmates) is that the drama is somewhat dependent on the group of girls. Girls are different social creatures than boys in elementary - that's for sure! But not all cohorts of girls have the same issues with drama, and some teachers are better at handling it than others. The other thing I've heard - and seen happen with my ds' friends who are now older - is that once the drama-filled girls get through puberty (which can be a whole 'nother escalated level of girl drama!) the drama subsided and they turned into truly accepting, calm, really nice friendly girls


I'd suggest you spend some quality time reading the material that Pete Wright (www.wrightslaw.org) has put together. Grades are irrelevant (legally) for a 504 plan - but the school may be "ok" in not writing up one from a different perspective - the 504 is put in place to assure FAPE for students with disabilities - *if* the school doesn't already provide FAPE. Your school may be making a best attempt to provide FAPE through the behavioral plan. We had a similar situation with a medical issue for our older dd. Many children in the US with similar medical needs have 504 plans, but our district will not write one for it - instead they have their own "health plan" which essentially is meant to provide the same FAPE.


I don't know how frequently differences in scores such as this occur, but I'd want to know more about why the difference. I also don't know for sure what the standard deviation and norm are on the kbit, but if the norm is 100 and the SD is 15 (which is typical for quite a few of these types of tests), then your dd has a relatively high verbal score and a difference between verbal and nonverbal of greater than 1.5 SD - which is a potential red flag for a potential LD. It's possible the split you see on this one test has nothing to do with anything - perhaps your dd was bored during the test and checked out, maybe it was too brief of a test to get a full picture etc. OTOH, when you see a split like that in testing and you know that the student is having difficulty in either life or school - it's a good idea to follow-up with more complete testing. A neurospych eval typically includes one of the more thorough individual IQ tests such as WISC and achievement testing, as well as a detailed parent interview and developmental history. The neuropsych will look for clues in all of that to explain why a split in scores exists, and typically also includes other types of testing such as executive functioning, visual motor integration etc - depending on what they see - to help discern what is going on.

While you wait for the neuropsych testing, I'd do two things. First I'd think through her academic performance in school - do you feel that there are any areas that are frustrating to her? Not just the social issues, but specifically academics. Next, I'd request an IEP eligibility review. There are things you've mentioned here that suggest, to me, even with her current anxiety and ADHD diagnoses - without any other clarification from a neuropsych eval - your dd might qualify for an IEP. You might want to see if you can find a parent advocate's group in your area to help you with advice - we found our local group by looking through the yellow pages list on wrightslaw.org. The benefit of consulting with a local advocate is that they know the ins and outs of your particular school district and are familiar with the politics that often come into play - such as the comment that you've heard that grades disqualify a student from receiving a 504.

If you can get your child an IEP eligibility review, you will most likely get testing that will give you more detailed info. My experience has been it's not as useful as neuropsych testing (the upside to private neuropsych testing is two-fold - the tester has no bias or motive to not fully explain or delve into what is up with the test results, and it is typically more thorough) - but it's worth pursuing in spite of the possibility it might not be "enough". I'd just go into it realizing you'll need to do your research to understand your rights, and to know what you really want to ask for - at the end of the day, you'll need to be the expert on what your child needs.

Hope some of that helped! Hang in there -

polarbear

I really appreciate everyone who has taken the time to respond. It allows me some possible insight into E's world.

Sometimes she's very upset about her lack of friends; and other times she's happily playing alone, pretending, dressing up, doing a puzzle, reading her presidents books, creating a mess (i mean art ;-)) I do not care one bit if she only has 1 friend or 1449; I just don't want her self esteem to take a significant hit while we're figuring it all out.

another point of concern is possible prenatal exposure to alcohol, cocaine, and marijuana until about the 4th month of pregnancy. her birthmom is a recovering addict, but did struggle during the first part of her pregnancy.

Polarbear-other than socially, I don't see her consistently struggle academically yet. She definitely prefers reading over math, but sometimes her brain just "clicks" in math...I don't know how else to describe it. It has to be on her terms..for instance, the other night she was counting by 6's, 7's, and 8's fairly quickly. If I asked her to do it, she wouldn't be able to as quickly. The other thing, she doesn't do well on comprehension tests at school, but she can summarize a story she's read very well at home. I think that's due to distraction/inattention. Once I challenged her to get 100% on her comp test, and she did. She was very excited to bring it home to show me she did it. Then she missed 3 questions on the next test. Inconsistent. She is a phenomenal speller.

I'm very interested in the visual issue...dd intermittently complains her eyes bother her. I had chalked it up to allergy symptoms. She's had a normal ophthalmology exam, which I just now realize is different than a developmental optometrist exam.

Since school is already out, my plan is to research this summer the laws regarding 504s and IEPs. I had placed a phone call to an educational advocate a few months ago. I never heard back, and I've been so overwhelmed, I never followed up. I've emailed her OT to see if she is doing social skills groups this summer. I already filled out the form for a neuropsych to get started. My new insurance kicks in July 1st. The other thing I'm excited about (I don't get out much), is the only developmental optometrist in the area takes my new insurance, too. I may go ahead and make an appt for dd, since I'm not sure of the wait time on the neuropsych.