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    Joined: Aug 2014
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    Originally Posted by aeh
    Processing speed is particularly important to fluent written expression and automaticity in calculating. Fourth grade in many schools marks the transition to a significant increase in expectations for lengthy or analytical writing and math problem solving (which is much easier to do if one is not bogged down with calculations that should be automatic, like multiplication facts). Is it possible that the behaviors are symptomatic of difficulty meeting academic expectations, not necessarily because of intellectual reasons, but because of learning difference reasons?

    My daughter is a fluent writer, with good handwriting. She is a poor speller, and can spell the same word wrong more than one way on the same page. However, she is still one of the better spellers in her class, so maybe standards are just low these days.

    In math, she does have to work a bit harder. Multiplication tables do not come naturally, and she makes some mistakes. Even her better IQ score does not have her as HG, so I'm not sure what level of math performance is normal for a bright/MG child and what is a processing issue.

    I do not know about underperforming. Most of her attention issues come from executive function--she has difficulty staying on task for undesirable or tedious tasks.

    I do think there's a 2e situation, but the evaluator diagnosed General Anxiety Disorder and not ADHD. She was very distracted (as low as the 4th percentile) on the PIA, but because she still answered accurately in about the 50th percentile, he said no to the diagnosis.

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    Just a few random thoughts for you:

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    In the two years since, she has thrived in the program, which is pull out one day/week. We have been noticing some attention and maturity issues, more at home and in her regular classroom than in the gifted program, and wanted to get a full evaluation.

    It could be that the reason you notice the attention and maturity issues in her regular school program vs in the gifted is due to the way the class/day is structured and the types of material covered, not just due to academics - this is a total *guess* of course, but the instructional approach and the types of projects, and amount of noise, activity, free-thinking etc that was allowed in our school district's gifted elementary school pull-out was extremely different than much of what went on in the classroom and it was in many instances an easier environment for kids who had ADHD or similar challenges to cope in. The activities also focused a lot on brain work, experimenting and discussing rather than the rote types of worksheet, repetitive exercises, etc that went on in regular class - so sometimes for kids who had LDs even (like my 2e ds) it was an easier place just to be, much less anxiety provoking than a regular classroom.

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    My daughter is a fluent writer, with good handwriting. She is a poor speller, and can spell the same word wrong more than one way on the same page. However, she is still one of the better spellers in her class, so maybe standards are just low these days.

    How are you making the determination that she's one of the best spellers in class? Based on what you see in written paragraphs/stories of other kids etc, or based on spelling tests? Memorizing words for a spelling test is a bit of a different skill than spelling while writing - when you're in the middle of the act of writing there are quite a few other things to pay attention to such as grammar, punctuation, neatness, and of course, the ideas you are trying to put into the written words. I don't think it's terribly uncommon at your dd's age to spell better for tests than while writing. One thing that was different in our elementary school today than when I was in elementary school is that our kids' teachers didn't make them over-think spelling while writing, they wanted them to focus on ideas. Judging growth and ability in spelling accuracy was left for spelling tests. When they had writing assignments, the teachers usually had them circle two words that they found that were spelled wrong and correct them and that was it, no worries about the rest. When our kids were doing writing assignments for homework we (parents) were specifically told not to stop them while writing to correct spelling.

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    Most of her attention issues come from executive function--she has difficulty staying on task for undesirable or tedious tasks.


    If you make a list over time of the specific tasks she has the most difficulty with staying on task, do you see any trends re the type of task? Any ideas of what makes the task undesirable or tedious?

    With both symbol search and coding relatively low scores for your dd, I'm wondering - is there any possibility she might have a slight vision issue? Those tasks both depend on vision.

    Was there any kind of behavioral survey completed by parents/teachers included as part of the eval? Was there any executive function testing other than the ADHD test?

    It sounds like you had an inexperienced, disinterested tester. If the degree to which you're seeing attention issues in your dd seems large to you, or if it's interfering at school, it would be helpful to have a more in-depth eval which would look into specific issues such as why the processing speed scores (both subtests) seem low relative to the others, etc.

    I'm also just curious what the test was where the tester asked your dd to make up stories - it doesn't sound like anything I've heard of before, so just curious!

    Best wishes,

    polarbear




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    Multiple spellings of the same word, especially multiple unique misspellings, is a clinical indicator that I would not ignore, even if she is one of the better spellers overall in her class. Most poor spellers use the same misspelling repeatedly in any given session of writing. (As a result of weak spelling strategies.)

    Does she understand multiplication, but struggle to memorize them to the point of automaticity? Those are two different situations (poor conceptual grasp of multiplication vs poor fluency with multiplication).

    Anxiety does have impacts on attention and working memory, and certainly is a reasonable hypothesis. There are also some indications from MRI data that it has some negative interactions with mathematics.

    Additional information I would look into would be spelling skills: Phoneme/Grapheme Knowledge on the WJIII, Spelling on the WIAT-III, KTEA-II/III, WJIII/IV, or TOWL-IV would be some options. Academic fluency skills: Math Fluency, Writing Fluency, Reading Fluency on the WJIII/IV or KTEA-III, or Math Fluency, Oral Reading Fluency on the WIAT-III, or various dimensions of oral reading on the GORT-5.

    Basically, I think you need more information to be able to meaningfully reconcile the two assessments you have had so far. This information should include academic achievement testing, including some of the areas I've listed above, and probably slightly more in-depth social-emotional assessment and executive function, given the Dx of GAD. Whether you pursue additional assessment depends largely on how unhappy or stressed the existing schooling situation is making your daughter and your family as a whole.


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    I'm a bit embarrassed to admit that I'm basing my opinion on her spelling compared to peers on school spelling bees. She's usually a finalist or runner up in her class of 25 (mainstream class).

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    Just realized I missed a couple of posts.

    To the story-telling task: this may have been a projective social-emotional measure, which would then explain a bit better why he felt that GAD was a better Dx than ADHD. Keep in mind that the majority of apperception tests (TAT, CAT, SAT, TEMAS, Roberts-2), with the exception of the Roberts, have no objective scoring scheme, so they rely solely on the clinical skill of the examiner.

    Alternatively, it could have been an expressive language test, which would relate to his comment on the complexity of her response.

    Which one of the above it was should be evident from the list of assessments administered.

    Reflecting on what you've posted so far, I also wonder what you would see if an SLP looked at her expressive language versus her receptive language, as that can be a factor in the difference between the Vocab/Sim and Comp subtest scores on the WISC. And could factor into the reported inattention.

    And finally, the cut/paste reports are one of my pet peeves. That, and computer-generated reports. I write my narratives from scratch, for each student.


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    It was the Children's Apperception Test.

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    The undesirable tasks include stopping reading to get ready or do chores, or even have a conversation if she's not in the mood.

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    She also is very impulsive and has difficulty reading social cues. At this point in her life, she is socially affected much more than academically. Socially, she's struggling. Academically, she's been doing fine, although I'm obviously concerned about latent issues that would cause trouble in the future.

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    Multiplication problem is fluency. She gets the concept, but can't always recall them quickly and has to figure them out manually.

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    Originally Posted by fireball45
    She also is very impulsive and has difficulty reading social cues. At this point in her life, she is socially affected much more than academically. Socially, she's struggling. Academically, she's been doing fine, although I'm obviously concerned about latent issues that would cause trouble in the future.

    Ah, that would explain the relatively lower Comprehension and Picture Concepts scores (which also happen to be the subtests not on the WASI-II). Comprehension draws largely from non-academic, experiential knowledge, and thus has a lot of overlap with social reasoning. Picture Concepts is also an every-day life kind of task, and requires examinees to make connections between visual images of common objects. The two together suggest that she currently is not as skilled at reading nonverbal cues (largely visual in nature) in social situations, or at the related skill of translating such social information into language. Weaknesses in social perception or social problem-solving are not all that unusual in children with LDs or ADHD (although we usually associate this with ASDs).

    I would still be concerned about her academics, as she goes into the next stage, especially with automaticity in spelling and calculating, which sound vulnerable to me, from your description. At some point in the very near future, when all of her classmates have mastered multiplication facts, her lack of fluency will begin to hold her back in her cohort, as problem-solving and multiple manipulations become the rule, rather than simple calculations. Something similar often happens with spelling. Although she is the top in her class, if she continues to make unusual spelling errors, whether due to lack of automaticity, lack of effective spelling strategies (there is only so far you can go with rote memory), or weak self-monitoring (characteristic of ADHD/executive dysfunctions), teachers will begin to judge her on her spelling rather than the content of her writing, or she will begin to self-censor her vocabulary to reduce the chance of spelling errors. Neither is a desirable outcome.

    You might consider having additional evaluation in executive functions done. There are children who are not ADHD, because they don't have clinically dysregulated attention, but do have deficits in inhibition (impulsivity). If you do pursue further eval, make sure to mention that impulsivity is a concern as distinct from ADHD.


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