Dr. Devon MacEachron\'s Blog

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There was a debate recently on a neuropsychologists listserve I’m on about the use of assistive technology (AT). At least half the psychologists who wrote in felt strongly that it’s just a crutch and that students who use AT will never learn the critical basic skills they need. Accommodations like extra time, calculators, and testing in a quiet room were also criticized. One wrote “you wouldn’t want a dyslexic surgeon who uses AT operating on you in the emergency room.”

I disagree. My advice to most parents is to try their best to remediate learning challenges while the child is young and doing so doesn’t negatively impact their high school and college trajectories. But after a certain point, there are diminishing returns to remediation. Furthermore, it’s critically important that the child focus on higher order skills like reading and oral comprehension, communication, and mathematical problem solving. The lower order skills like word decoding, spelling, and math fact memorization are certainly helpful, but one doesn’t want to stagnate at that level. And, one wants to keep that spark of intellectual curiosity and love of learning alive, and year after year of remediation can take a toll.

Assistive technology can have a huge impact when the decision is made to slow down or stop dyslexia remediation. Or at any point when a learner would benefit from better access to reading, writing, and higher-level math. I’ve seen students who didn’t read at all suddenly become avid readers when they could access text by listening to it. My dyslexic son taught himself to listen to books at triple speed and describes that as a “game-changer” professionally. He’s just launched a start-up in the space of virtual reality and education. Who says all learning has to happen the same way it has since the invention of the printing press in the 1400’s?

The options in the field of AT are simply amazing, and are growing every day. There’s a terrific, up-to-date guide just published by Dyslexic Advantage called Tech Guide 2017 that I can’t recommend more highly. It describes all the newest and tried and true AT out there with comments, reviews, and links to YouTubes and other instructions for use. One has to become a premium member in order to get the guide, but I believe the price ($60) for membership is worth it for this guide alone. For those of you not familiar with Dyslexic Advantage, it’s a non-profit founded by Dr.’s Brock and Fernette Eide with the mission of celebrating dyslexic strengths and bringing “more of the incredible talent and innovative thinking of this community to the world.” The good doctors wrote the books: The Mislabeled Child: How understanding your child’s unique learning style can open the door to success and The Dyslexic Advantage: Unlocking the hidden potential of the dyslexic brain. I adore these two and am so grateful for all they have done and are doing to shift the dynamic for dyslexics. If you’re interested in joining Dyslexic Advantage and getting the guide, here’s a link to do so: Premium Membership.

In the introduction to the guide they suggest taking one’s time and not hurrying tech learning. There are a lot of different applications from which to choose, and the choice can be a bit overwhelming. Kind of like trying to decide what to watch on t.v these days, and how to access it: Netflix? Amazon? Hulu? Apple TV? Also, there may be challenges initially in learning how to use a new technology. One may need to put in some time training oneself and training the technology to work for the individual. I’ve seen students give up way too early when trying out a tool like Speech-to-Text interface or Inspiration. It often helps to hire an assistive technology consultant to guide one through the selection and training stages. Consultants can be found in most areas, but if there isn’t one near you they might be able to help remotely.

I’m so excited about the tools out there. From audiobooks, books combining audio and visual presentations (even graphic novels), pen scanners that read text aloud, speed reading apps, note-taking tools, speech-to-text, text-to-speech, apps with prompts for writers, typing programs, and tools for organization and executive function – there’s something for everybody. Even us non-dyslexics.

I am thrilled (as I did recently) when I learn my surgeon is dyslexic. That’s because I know they probably have exceptional visual-spatial and big-picture thinking skills. They had to work extra hard to get where they are so they’ve got a great work ethic and are smart and motivated. And if they’re familiar with AT on a personal level they’re likely to have investigated the ways in which technology can enhance their work as a surgeon. No one would want to have a surgeon using tools and techniques from the 1400’s. Why should education be stuck in a time warp?

The frequency of misdiagnosis, especially of gifted and twice exceptional students, is one of the reasons I decided to go into the field of assessment as a specialist in these populations. Too many families go to the trouble and expense of having an assessment conducted only to be given incorrect or incomplete information about their child. I have been through this myself as a parent. And I have seen it time and time again among the families I work with. Misdiagnosis can create lasting damage, derail children’s educations, and result in worried days and sleepless nights for children and parents.

Why does this happen? Here are the top ten reasons  gifted and twice exceptional children are misdiagnosed:

1. Hidden abilities and weaknesses: Most gifted and twice-exceptional learners have complex profiles with unique patterns of strengths and weakness. Their strengths often camouflage the expression of their weaknesses (resulting in failure to identify learning difficulties or disabilities) and their weaknesses often camouflage the expression of their strengths (resulting in failure to identify strengths and giftedness). What on the surface may appear to be an average student is often a student with exceptional abilities and exceptional weaknesses “averaging” one another out.

2. “Symptom” confusion: The markers of conditions may appear to overlap. Gifted learners and learners with ADHD both have low tolerance for boredom. Gifted learners and learners with Asperger’s both have a tendency to focus intensely in areas of personal interest. Students with dyslexia may appear to have ADHD if they act distracted or disruptive when its time to read aloud or write.

3. Interaction of the organism (the child) with its environment: Remember gene-environment interaction from high school biology? The influence of the environment on development cannot be overstated. A child who appears to have ADHD in a school where he or she is having to sit through boring classes in which they already know most of the material may not appear to have ADHD at all when placed in a challenging gifted program. And sometimes it is the interaction with a specific teacher that causes the problem. Have you heard the expression “I don’t have a learning disability – my teacher has a teaching disability?”

4. Lack of training in giftedness and twice exceptionality: The psychologist conducting the assessment may not have received much training, if any, in these areas. You may be surprised to learn how little time is spent in most psychology training programs on the assessment of intelligence and learning. Most programs include no training in giftedness or twice exceptionality whatsoever. Furthermore, because many psychologists who conduct assessments work with a broad variety of children and do psychotherapy or other kinds of work in addition to assessment, their knowledge of giftedness and twice exceptionality may not grow much with experience. Some may see only one or two gifted or twice-exceptional students a year. Teachers tend to be equally unfamiliar with the characteristics of these children.

5. “Gifted” is seen as a four letter word: Some kind-hearted people think that it is elitist or unfair to describe or think of a child as gifted because it implies that they are “better than” or “superior” to others. This may be driven by a desire to be inclusive, treat everyone equally, and make people feel good. Strangely, not every child is expected to be equally gifted at sports where it is “allowed” to describe a child as athletically gifted. But it isn’t very “politically correct” to focus attention on intellectual giftedness and really hasn’t been since the 1950’s.

6. Misinterpretation of diagnostic criteria: The criteria psychologists use to make diagnoses are generally taken from the APA’s Diagnostic and Statistical Manual (DSM-5). One area of misunderstanding is that psychologists and school staff may be under the impression that a student has to be performing below the average level (e.g. below the 25th percentile) for their age or grade to be diagnosed with a learning disability. This is actually not true. Under “Diagnostic Features” the DSM-5 states: “academic skills are distributed along a continuum, so there is no natural cut point that can be used to differentiate individuals with and without specific learning disorder,” and “specific learning disorder may also occur in individuals identified as intellectually gifted. These individuals may be able to sustain apparently adequate academic functioning by using compensatory strategies…” Thus the code acknowledges that a gifted student may perform at the average, or “apparently adequate” level, yet still have a learning disability. But many school staff and even psychologists haven’t read the fine print.

7. Incomplete, cursory assessment: To do a top-notch assessment requires gathering a lot of background data and test data while applying critical thinking skills, testing hypotheses, and being willing to keep looking until the answers are revealed. While some diagnoses are clear-cut and relatively easy to make, most gifted and twice exceptional learners are harder to figure out. Not every psychologist is eager to dedicate that much energy and time. Time is money. Sometimes parents are the ones hoping for a quick fix to what may actually be a rather complicated problem.

8. Emotions get in the way: Parents may want their child to be diagnosed with a learning disability because it seems more hopeful than being told their child has a general intellectual disability. Or because it explains why they are under-performing despite high ability when the real problem is social, emotional, or family problems. Conversely, they may not want their child to be diagnosed with a disability because they feel it would be stigmatizing. Sometimes the emotions or preconceptions of the psychologist influence them to downplay findings to protect parents and child from disappointment. I’ve seen reports that pussyfoot so timidly around a diagnosis that parents are left mistakenly thinking there was nothing they really need be concerned about. This seems to be particularly common with autism/Asperger’s diagnoses. And ADHD. And emotional and behavioral problems.

9. Not observing and listening to the student: It never ceases to amaze me how much even very young children know about themselves. Of course they may not come right out and say it, but if they are observed carefully and asked the right questions in a welcoming and nurturing environment, amazing insights come out. Perceptive, sensitive gifted learners have finely tuned antennae making them profoundly aware of exactly where they are not doing as well as their peers or as they’d like. All one has to do is observe and ask.

10. Not observing and listening to the parent: Even though few parents have been professionally trained in picking up these kinds of clues, I find that they often are the first to notice something is up – and the most persistent to find solutions. If they raised the issue with their pediatrician they may have been told it was probably developmental and not to worry. If they raised the issue with their child’s teacher they may have been told their child was at grade level and not to worry. But parents are really good at worrying. When they “know” or “feel” something is up, they should trust their instincts. They’re often right.

If I can help you understand your gifted or twice-exceptional student better, schedule a time to talk with me by e-mailing dm@drdevon.com.