Gifted Issues Discussion homepage Forums Twice Exceptional Feels like 2E...

Hello. New here and looking for a little guidance from others who may have been down this road already.

We recently had DS (9 1/2 years old) undergo a neuropsych evaluation to rule out ADHD. His Montessori teachers had been complaining about him for several years, saying he wasn't engaging with the material, reporting various disruptive behaviors, and implying (but never requesting) that we should do something (non-specific) about it. They had no concerns about him academically; he just seemed to be unmotivated, class clowning, lacking self-regulation, etc.

We also have noted tendencies to be strong emotionally reactive, impulsive/lacking self-control, and needing lots of prompting to complete tasks in the home environment. Since the school wasn't seeming to have any ideas on how to help, and individual therapy for more than a year didn't seem to be changing anything in the classroom in a significant way, we thought maybe an evaluation would reveal a diagnosis that could help make a significant difference in the daily struggles.

Results revealed a moderately gifted profile, pretty balanced overall (with outliers VSI 147, PSI 105) and the giftedness (and suspected lack of proper educational setting) are what the neuropsych focused on in her recommendations.

However, in doing so, she seems to have blown past elevated or very elevated subjective ratings from us parents in the categories of Inattention, Hyperactivity/Impulsivity, and Defiance/Aggression, and though her report even talks about her own observations of dysregulated behavior during the evaluation ("He was more impulsive and silly on the second day. He hid under the examiners desk, turned off the lights, took materials from the examiner�s desk, and made inappropriate comments."), she attributes this behavior to his giftedness and the inappropriate educational setting.

As much as I really WANT to believe that changing schools (which we will do for next fall) is going to magically fix everything, I feel skeptical that the behavioral issues will evaporate and am worried about where we'll find ourselves if the same thing happens all over again at a gifted school.

In short: we don't have a diagnosis for him, but our experience of him FEELS 2E. I know that's vague, and I feel a little silly suggesting that I might know better than a neuropsychologist does!! I just don't know what to believe (or how to proceed), and I don't want to set him up to fail in a new educational setting because we haven't adequately identified a plan for dealing with ALL of his challenges.

Any advice or experience to share?

Welcome!

I would wonder a bit about the accuracy of his description as evenly MG, with outliers in the EG/PG and average range. Because of how the FSIQ is derived, these outliers may have less impact on his overall composite score, obscuring possibly important diversity. A 42 point index score range is not insubstantial. If you feel comfortable doing so, we may be able to give more specific feedback if you post index and subtest scores. (If you don't, you are welcome to pm me, as an option.)

No problem, wasn't sure what would be helpful. Trying to give this in a format similar to what I've seen in other posts. Let me know if this isn't the best way. I have other tests too (CPT, DKEFS, TEA) for which I can post scores if it is helpful. Thanks for taking a look!

WISC-V

VCI 121
Similarities 12 75th
Vocabulary 16 98th

VSI 147
Block Design 19 99th
Visual Puzzles 17 99th

FRI 131
Matrix Reasoning 17 99th
Figure Weights 14 91st

WMI 127
Digit Span 16 98th
Picture Span 14 91st

PSI 105
Coding 10 50th
Symbol Search 12 75th

FSIQ 134

ADHD is a diagnosis of elimination, so it's normal for neuropsychology to identify discrepancies but not actually diagnose ADHD. Just some of the things *I know of, in my family* that can cause ADHD-like symptoms are lead poisoning, attachment disorder, sleep disorder, anxiety, traumatic brain injury, and orthostatic tachycardia (resulting in cerebral hypoperfusion).

Neuropsychology identifies the discrepancies, while a therapist and/or pediatrician rules out the mental health and physical diagnoses which can cause the symptoms of ADHD. If no other cause for the symptoms is found, THEN the child receives an ADHD diagnosis and treatment may proceed.

Her report details these behaviors because they are significant behaviors in future diagnosis of ADHD, and because inattentive behaviors are likely to lower his scoring.

I strongly recommend pursuing ADHD evaluation. When the cause of his inattention is discovered and treated, I strongly recommend repeating the IQ testing.

My son's first IQ test resulted in FSIQ of 68th percentile - high average. After ADHD diagnosis and treatment, his GAI was 99.8th percentile. You and your son's school may be underestimating his ability and his lack of proper educational setting may be significant.

You know your DS better than any neuropsychologist on Earth. You are the world's leading expert on your DS! Don't ever discount your own expertise and what your gut tells you. The times that I have overruled my intuition and proceeded against it have been my biggest parenting mistakes. My DS is ADHD and you describe classic ADHD behavior in your post, silliness and impulsivity, emotional reactivity, needing repeated prompting, not just at school but at home too.

I have come to realize in parenting an ADHD kid that lack of impulse control is really the gravamen of ADHD although the focus of treatment is on attentional struggles. It's the impulse control issues that disrupt attention. Let me tell you from where I sit with DS16 that he began to have significant social struggles at school around the age of your son. Other kids don't like a disruptive kid who blurts things out all day every day in class. My DS is by temperament a very sweet, loving kid, lacking any of the aggressive issues that can occur with ADHD. However, his complete lack of impulse control coupled with the inability to read social cues and situations (ADHD kids are 2-3 years behind neurotypical kids in social maturity generally) made him a virtual outcast at school around 5th grade when the other kids started maturing socially. And he was medicated for ADHD and in therapy for it as well at that time.

So, all of this to say, trust your instincts. RUN, don't walk to have ADHD thoroughly assessed and controlled, if needed, to support your DS academically and socially. Good luck!

Chiming in to add celiac disease to sanne's list of conditions that can cause ADHD-like symptoms; if he has any symptoms and/or if autoimmune conditions run in your family, consider asking for the screening blood test.
https://celiac.org/celiac-disease/resources/checklist/
https://www.verywell.com/gluten-and-adhd-562627
https://www.ncbi.nlm.nih.gov/pubmed/21977364

I replied to your pm.

My 10 year old had the same types of behaviors (and IQ scores!)and we put him on a low dose of ritalin mid year. He has always seemed sort of "borderline" ADHD. It is hard to tell what is anxiety, what is boredom, what is normal boy behavior He improved a lot according to the teacher after the meds and also his own self reports. He was accelerated in math and in a gifted program before and after the meds so I believe it was not boredom, it was ADHD. You can get a provisional diagnosis.

I think that I am hearing from some of you that that further exploration of a possible neurological cause for his behavior (other than "childhood") isn't out of line. But... what's the next stop after a neuropsych? Really, the whole point of the evaluation by the neuropsych was to diagnose or rule out ADHD!!

[Side note: at his last well-child visit with his pediatrician, when I brought up possible ADHD, the doc asked somewhat rhetorically if he was learning anything in school... implying that he wasn't even going to entertain a conversation about an ADHD diagnosis. I'm not sure if that is based on his quick observations of my son or preconceived notions about misdiagnosis of ADHD, but I do know he didn't dig at all into what my actual concerns or observations were. However, I would expect further conversations with the pediatrician not to be fruitful.]

Bottom line, I expected the buck to stop with the neuropsych, and am really confused as to who to go to from here. Also, I am cognizant that if I keep asking doctors, eventually I will find someone who will diagnose my son as ADHD. That isn't my goal - helping him with *whatever* help he truly needs is my goal.

You could also try a developmental pediatrician, or a child psychiatrist. Be aware that psychiatrists are predisposed to medication, but that doesn't discount the value of a really good diagnostician.

Take all the data you currently have to the next evaluator.