Gifted Issues Discussion homepage Forums Twice Exceptional Difficulty learning/retaining information as teen?

My now-11th grader (will keep this gender-neutral for privacy) has academic struggles that I don't understand. This is a kid who presented as highly gifted as a young child - started reading at 3, seemed to love learning, was very creative and clever, great memory. They started a gifted program in the middle of elementary school and did well until around 5th/6th grade. At some point, their performance started slipping, especially in math but also in other areas (previously strong writing ability seemed to decline relative to peers, for example). Because kid seemed a little spacey and unfocused, we had them tested for ADHD. Evaluator found no ADHD or anything else that would impact learning. FSIQ was 142, with particular strengths in fluid reasoning.

During virtual school/Covid, kid started showing signs of depression and was prescribed meds. We also had kid reevaluated for ADHD. This time, the evaluator said they did have ADHD. However, this is an evaluator known for giving out diagnoses freely, so I've always been a little skeptical of that. Nonetheless, they started taking ADHD meds, which seemed to help with some things.

Kid's mental health is now better. In high school, they've had almost all As. They work pretty hard although tend to procrastinate. This year, however, they completely blew a couple of tests (getting grades of like 40/100) despite preparing for them. This caused us to look under the hood of their academics a bit with somewhat bracing results. A lot of their good grades seem to be the result of grade inflation. Kid is making extremely basic mistakes in math, science, foreign language, and to some extent with English usage. For example, kid is in an AP language class for a language that they have been studying since childhood. Some of their writing in that language shows extremely elementary mistakes with things like subject-verb agreement - things you'd expect that a first-year student in that language would know not to make. Same thing with math problems - kid is getting very basic things wrong.

We increased ADHD meds and kid is working with a tutor in the classes where they are underperforming. Things are going a little better and grades may be salvageable for college. However, I don't feel like I understand their learning difficulties at all, despite talking to them and working with them on a lot of their academic issues. The key issue seems to be that they have a very difficult time retaining information - will correct a mistake with guidance but then make exactly the same mistake the next time. If I didn't know any context, I'd say that the kid is in overly advanced classes and should drop down a level. But with past evidence of giftedness, I'm not sure that's the right answer.

Can ADHD have effects like this? Is there something else we should be investigating? I want to emphasize that we love our kid as they are and don't want to push them to be an academic superstar if that's not the right path for them. At the same time, their performance is difficult to reconcile with what I've always thought their abilities are, and if something is getting in the way of their learning, I'd like to address it.

A few things to consider:

* I’ve been told that puberty can affect how adhd presents, so that may have something to do with it and might be worth looking into further. Additudemag.org has lots of articles available for free.

* you can look at this book: Misdiagnosis and Dual Diagnoses of Gifted Children and Adults. You can read through the adhd dual diagnosis and misdiagnosis sections to see if that gives you any new insights

* the person assessing adhd was probably a psychologist. But they don’t see all potential issues. What about motor skills? What about vision? What about hearing? What about sensory processing? Sleep apnea? Is there any behavior or experience you’ve had with this child that doesn’t seem to be explained the current diagnosis? Try to get the appropriate terminology for what you observe and see if that comes up as a symptom for other issues.

* if you have a neuropsych report, read back through it and see if there were any parts that you don’t fully understand and read up on those topics, it may lead you to something important. You can also look back through standardized testing looking for patterns.

* ask your kid what is causing problems. My kid would tell us things that didn’t seem logical or supported by the teachers observations …. But, now that we have a better understanding and diagnosis, his responses were incredibly honest and represent his lived experience.

I read my kids neuropsych report a million times trying to understand it. I realized there were some behaviors/experiences it did not explain. I read up on a certain type of memory so I could understand the report results and came across a list of symptoms for a diagnosis that explained a cluster of behaviors. I found testing, he got diagnosed, now he’s accommodated and we understand him a lot better! Literally like detective work.

Hi finca,

I took a look back at some of our previous correspondence, which I think is about the same child, and was reminded that your DC does actually have a pretty distinctively diverse learning profile which predicts possible relative struggles in quantitative concepts (basic numeracy), higher-level math (especially geometry and trigonometry), possibly in automaticity skills (basic skills learned to fluency or "second nature"), and also possibly impacts on executive function, all in the context of exceptional verbal intelligence, abstract problem-solving skills, and auditory memory.

Since your current concerns are focused on memory and attention, I'll spend a little more real estate on that aspect: in prior testing, one of the significant personal weaknesses identified was visual sequential memory. Irrespective of ADHD (which is not the only form of executive dysfunction), executive functions turn out to be significantly impacted by the length and robustness of one's visual working memory span. Being able to mentally walk through and visualize (forward and backward) the component steps of a task is a critical aspect of how people manage time, plan, and organize complex activities. If both visual-spatial reasoning and visual working memory are relatively poor, this mental image of what one actually has to do, when, and how, in order for a task to actually get done, will be blurry or incomplete, which leads in practice to missing steps or materials, inaccurate estimates of time to complete tasks, etc.--> poor execution.

Can one actually remediate visual working memory? So far, the data would suggest no. (Although auditory memory spans for specific types of information can be improved--but only narrowly, for that exact task. E.g., one can practice to increase digit span, but it doesn't translate even to very similar tasks, like letter span. You'd have to do that one all over again.) However, clearly, this is a type of scaffolding that the majority of adults in our society benefit from, since there are innumerable products on the market that essentially help externalize the so-called whiteboard of the mind onto executive functioning aids. I.e., organizers, calendars, agendabooks and reminder tools.

If you felt it would be of value to further investigate her learning profile, the next direction I would look would be at a neuropsychological evaluation that includes detailed explorations of executive functions, not only for ADHD, but for the finer structures of memory. Our current understanding of memory includes a few different angles. I'll try to simplify:

-Along one axis, we can think about visual versus auditory-verbal memory. The data we already have on your DC is that the latter is very strong, but the former is (if I recall) more or less average (which makes it experienced internally as weak, even if it is normatively unremarkable). The diverse performance seems to be more clear than in some other cases, as the task used images that could be easily named (and thus converted to auditory-verbal content), which would, of course, take an extra step, but did allow your DC an avenue for compensatory strategies using exceptional auditory-verbal memory strengths. I would not be surprised if assessment with symbolic (not-easily named) images found even weaker performance.

-We can also consider the difference between sequential and simultaneous memory. The measures we already have is sequential only, so we don't have any hard data on this for your DC. Auditory memory is usually examined only in its sequential form. (Although there are simultaneous forms of it too, those are harder to assess using existing tools. An example of simultaneous auditory memory would be recall of chords, which include multiple pieces of auditory information at the same time.) Visual memory is easier to distinguish along sequential/simultaneous lines. Some people can glance at an image or a scene and retain substantial detail from it in any order, often because their memory of it is like an actual image, where they can go back and look through the memory to respond to memory questions. But for some of those same people, if you asked them to indicate a sequence of visual images, they would get the images correct, but not necessarily in sequence.

-Another major aspect of memory that might be relevant is that of cued vs free recall. Some do better with one than the other. In practice, this might look like differential performance on multiple choice (cued recall) vs open-response (free recall) assessments. Often the difference reflects organizational differences in the way memories are stored. When someone says, "I'll file that away in my memory," you might say that some people have very tidy, easily accessed filing cabinets, and others are just throwing everything into a big heap on the dining room table. Or the back hall closet. It's there, but not all that easy to get to. People who seem to have learned how to memorize lots of people's names in a short time (supposedly many politicians and royalty) often have figured out or been taught an organizational strategy for names (something like color-coding your folders), so they can easily retrieve a person's name when they see or hear the cue attached to that person's appearance, voice, association, context, etc.

-Memory also has different stages on its way to long-term storage. There's immediate memory (registration), which is just that first few seconds of impression, and then there's what we usually associate with working memory, which is what we can hold in our heads for temporary processing (this has been called the whiteboard of the mind), and then there's the transfer to longer-term memory (encoding). If there's a bottle-neck at any of these stages, the outcome at the long-term storage end will look the same, but for different reasons. You can support a small mental whiteboard or immediate memory by presenting information in forms that aren't ephemera (printed products, in other words).

Some of the above factors might be involved in the behaviors that suggest an automaticity deficit (difficulty with learning lower-level skills to fluency, despite strong higher-level abilities). In the lower grades, being able to problem-solve your way to the correct response when others are struggling through those same basic skills is advanced. At higher grade levels, having to problem-solve your way to basic skills when others have memorized them to automaticity forces you to to devote higher-level abilities to low-level tasks, leaving less processing power for high-level skills.