Dr. Devon MacEachron\'s Blog

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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.

Are you familiar with the 5 stages of grief?

They describe the stages people go through when they learn they have a serious illness, or have lost a loved one, or have gotten divorced or broken up with a significant other. I find these stages helpful in understanding how parents may feel after their child receives a diagnosis of learning disability, ADHD, Asperger’s, and even giftedness.

For many parents there is a natural “mourning period” – a period of time in which they eventually let go of the image they may have harbored of a “perfect” child with idealized characteristics, and accept the child they have instead been given – for all his or her unique and wonderful differentness. It’s natural for parents to have expectations and dreams about the child they will have one day. And it’s natural to be shaken up when one’s expectations and dreams are threatened. That’s where grief can come in. Parents may go through “stages of grief” as they “mourn” the loss of the child they thought they’d have before accepting the child they do have.

Stage 1 is Denial. The first reaction for some is denial. This stage can serve the function of providing emotional protection from being overwhelmed with the idea all at once. Parents may believe the diagnosis is incorrect or mistaken, and try to cling to a false, preferable reality of a “perfect,” or “normal” child. Second opinions may be sought. Symptoms may be dismissed as “developmental” or attributed to generalities like “boys will be boys.” The assessment report might be filed in the wastebasket. Of course it is possible that the diagnosis is inaccurate, and parents should challenge it if it doesn’t seem right. But at some point – if the shoe fits – it is in the child’s best interest for parents to stop denying it. It is very important that the professional charged with first explaining the child’s profile to parents do so with empathy, recognizing and pointing out the child’s many strengths, and providing recommendations that address strengths as well as areas of weakness. No child should be defined entirely by weaknesses, deficits, or disabilities.

Stage 2 is Guilt. As the shock wears off, it may be replaced with pain and guilt. Parents may feel it is their “fault.” Mothers may wonder if it was that one glass of wine they had when they were pregnant. Should they have embraced a more structured parenting style and told their toddler “no” more often? Should they have used organic baby food? Should they have asked their future spouse for a genetic screening test before they accepted a proposal of marriage? I find the guilt stage to be particularly prevalent among mothers who work outside of the home.

Stage 3 is Anger. Some parents may become angry and frustrated, especially at proximate individuals like school staff, teachers, and spouses. They struggle with “Why my child? It’s not fair!”, “How could this happen?”, and “Who brought those genes into the family anyway?” They may go to war with their child’s school, focusing their anger on trying to get the services he or she needs. They may hire an advocate to accompany them into battle. Often this is a good thing and results in the child’s needs being met. But sometimes parents get stuck in this stage and spend years locked in battle. This may not be the most beneficial thing for the child, who is waiting in the sidelines for services, and can create a “battle zone” mentality which is not conducive to a happy home life. Marriages may suffer, especially if one spouse is in the anger stage while the other is still in denial or guilt.

Stage 4 is Depression. A period of sadness, loneliness, and hopelessness may come next. Parents may feel a sense of despair that their child might not be able to lead a normal life, go to college, find a partner, and have a successful career. Sleepless nights may ensue. Parents may isolate themselves from relationships with others (e.g. friends with children who appear to be thriving in school) who they feel can’t understand what they’re going through. This stage can be particularly difficult for parents who feel they are in it alone – single parents and those whose spouses do not “buy in” to the diagnosis and plan of action.

Stage 5 is Acceptance. Acceptance is the final or “goal” stage. Acceptance means that parents bury the expectation of the perfect, normal, idealized child (whatever that means) and accept the wonderful child that they have – in all his or her uniqueness. Acceptance means realizing: “It’s going to be okay;” and maybe even: “It’s going to be great!” Equanimity comes with acceptance. Equanimity involves the ability to be calm and maintain composure even in a difficult situation.

As the parent of two twice exceptional children with learning disabilities and ADHD I’ve been through these stages myself. Disbelief and denial that there could be anything “off” given how bright my children seemed. Guilt that maybe this wouldn’t have happened if I’d parented with more structure or had them assessed when they were younger. Anger that their schools seemed unwilling to address their disabilities or their giftedness. Isolation, sleepless nights. Friends and relatives who didn’t “get it.” And finally…acceptance. And pride and joy that my children are unique and fascinating individuals with strengths they probably would never have had if they weren’t wired differently.

I’m still working on the equanimity bit. Calm and composed? Too much to expect!

I speak with parents all over the world about their twice-exceptional children. One thing that keeps coming up again and again in nearly every state and country is that no one believes them that their child could be simultaneously gifted and dyslexic. A parent senses something is amiss, but friends, family (sorry to say this – but this often includes husbands), educators, and even psychologists are skeptical. It can be a very confusing and lonely position for the parent who is trying to advocate for their child to be in.

Why do so many people have trouble with the concept that someone can be good at something and bad at something else? The gifted dyslexic reader is often good at higher order verbal and nonverbal reasoning and bad at phonological decoding and naming speed. These are very different abilities. It’s not all that different from being good at skiing and bad at ball sports like soccer. These sports require different skill sets – just as higher order reasoning and phonological decoding do.

To make matters worse there are well-meaning researchers and psychologists who have urged that we do away with using IQ tests in the diagnosis of dyslexia. But if we don’t use IQ in a discrepancy analysis to ascertain how much lower achievement is than ability it can be hard to find the gifted dyslexic. The anti-IQ, anti-discrepancy formula “movement” was driven by good intentions. Children from disadvantaged backgrounds with IQ’s too low to show discrepancies were being under-served. And yet they had very real reading challenges which needed to be addressed. One of the first articles that got a lot of attention was one by Linda Siegel published in 1989 titled, bluntly: IQ Is Irrelevant to the Definition of Learning Disabilities. Around the same time reading researchers established that the core processes impaired in dyslexia were phonological processing, orthographic processing, and rapid naming. So the well-meaning crowd decided to throw out IQ tests and focus on assessing those abilities.

The only problem – which no one seemed to notice – was that this left out the gifted dyslexic. I remember sitting in a conference at Berkeley listening to Linda Siegel present her views on the topic knowing full well that if I stood up and challenged the assumptions I would probably be booed out of the room. It was not politically correct to say that IQ mattered.

I agree that low IQ shouldn’t be a barrier to children receiving needed services. But I also feel that high IQ should not be a barrier. And it often is under the current educational/political climate.

Gifted dyslexics are often “hidden.” This is because their strengths can camouflage their weaknesses. Despite poor word-level reading skills, they may have such strong verbal abilities that they can guess what’s going on in text. Their reading comprehension and even their phonological skills may test in the average (often low average) range. Teachers may not notice anything alarming. True – they don’t gravitate to independent reading and they stumble when asked to read aloud, but they appear to get by.

Some people (educators and psychologists included) misinterpret the diagnostic criteria and make the assumption that someone only has dyslexia if they are failing their classes or performing below grade level or below the level one would expect the “average person” to attain.

Diagnosis of disability is based on criteria set forth by the American Psychological Association in the Diagnostic and Statistical Manual of Mental Disorders (the DSM-5) and in the International Classification system, called the ICD-10.

The DSM-5 does start out saying that to have a Specific Learning Disorder the student’s academic skills must be “substantially below” expectations for their age. Many people stop there and interpret this to mean that performance has to be below average, which may be defined as being below a standard score of 85 which is at the 16th percentile. Thus, a student with verbal ability at the 99th percentile and reading performance in the low average range at the 17th percentile may not be seen as having a disability. This is known as the “average person standard.” You’re only considered disabled if you’re not doing as well as the average person.

However, when one reads the fine print in the DSM-5 they go on to say that “average achievement that is sustainable only by extraordinarily high levels of effort or support” is evidence of disability. So if a bright dyslexic child is getting tutored and working harder than his peers and is still performing in the average range, that’s evidence of a disability.

The DSM-5 also says that “there is no natural cut point that can be used to differentiate individuals with and without” a learning disability. It’s not appropriate for a school district to use an arbitrary cut-off at some percentile or say that if the student is getting A’s and B’s they can’t have a disability.

The DSM-5 further states that intellectually gifted students can still have learning disabilities despite being “able to sustain apparently adequate academic functioning.” There’s a clear recognition here that a gifted student may perform at an average level and yet still have a disability.

By definition a learning disability is an “unexpected” difference between ability and achievement. A student who has exceptionally high ability and yet performs academically at a level significantly below expectations displays an ability/achievement gap that can be  evidence of disability.

And now let me direct you to some of the neuroscience to support this view. Dr. Fumiko Hoeft is a brilliant (Harvard,  CalTech, and Stanford educated) and stunningly beautiful neuroscientist at UCSF School of Medicine who strides into a room in 5” heels as if they were sneakers. She’s written articles for The New Yorker on How Children Learn to Read and at Understood on Stealth Dyslexia. A YouTube of a presentation she gave at a Dyslexic Advantage conference on the Brain Basis of Dyslexia shows in clear images that gifted dyslexics process language using the same less efficient pathways as non-gifted dyslexics.

Basically, what Fumiko has shown through neuroimaging is that you can be gifted and dyslexic. Thank you Fumiko!

Does your dyslexic child love to build or draw things? Is he or she fascinated by how things work? Does your child surprise you with his ability to “see” things in his mind’s eye? This may be evidence of a budding talent that can lead to a successful career in a field that relies on visual-spatial thinking.

Visual-spatial thinking is the process of reasoning (thinking) with visual images or pictures – with mental images. It involves non-verbal thought processes that are not based on words and language. People who have strong visual-spatial thinking ability can manipulate visual images in their mind, examining things from all angles, and can “see” a sort of slide-show or film of a process or event in their “mind’s eye.” Temple Grandin (who is autistic, not dyslexic) described visual-spatial thinking when she wrote: “My visual thinking gives me the ability to do a ‘test run’ in my head on a piece of equipment I’ve designed just like a virtual reality computer system. Mistakes can be found prior to construction when I do this.” Albert Einstein wrote: “the entities which seem to serve as elements in my thought are certain signs and more or less clear images which can be voluntarily reproduced and combined…this combinatory play seems to be the essential feature in productive thought. The above-mentioned elements are, in my case, of visual type. Conventional words or other signs have to be sought for laboriously only in a secondary stage.”

For years people have wondered if individuals with dyslexia, who have weaknesses in left-brain-based language processes, might have higher than average right-brain visual-spatial abilities because of the different way their brains are wired. It seems logical that “that the same brain organization that leads to language disabilities for dyslexics might also lead to certain high level abilities.” (Norman Geschwind).

The scientific evidence has built to suggest that many dyslexics do, in fact, have stronger visual-spatial abilities than their non-dyslexic peers. Dyslexics evidence an enhanced ability to process visual-spatial information globally (holistically) rather than locally (part by part). This may be why individuals with dyslexia are over represented in fields such as architecture, art, engineering, and the sciences. In discussions with successful dyslexics in these fields the capacity to “see” things differently comes up with remarkable frequency.

My dyslexic son displayed a talent in visual-spatial thinking at a young age. Because so much of his school day was spent feeling less capable than his peers, we decided to focus on enrichment in this interest/talent area so could feel good at something. We bought books about how things work, helped him enter a Lego building competition, enrolled him for the Johns Hopkins Talent Search Spatial Test Battery, let him take apart and build mechanical objects around the house, enrolled him in summer engineering programs, helped him find an internship at an engineering firm, and did everything we could think of to help him develop his strength. Being good at something helped him get through the elementary and middle school years with his self-esteem intact – and ultimately helped him get into a good college because he had achievements in an area of passion. He majored in physics and is now a rocket engineer. He feels that his ability to picture things in his mind has enabled him to design original parts and envision how the engineering development process will flow better than many of his non-dyslexic peers.

When I work with dyslexic children who display an exceptional strength in an area like visual-spatial ability I often describe it to them as a “super power.” Something that makes them special and unique.

Drs. Brock and Fernette Eide, who founded  Dyslexic Advantage, have developed questionnaires to help identify the strengths associated with dyslexia. I’ve adapted some of their work to use in my assessment practice.

If you answer “strongly agree” or “agree” to a majority of the questions below, your dyslexic child may have a gift at visual-spatial thinking – a “super power” that could lead to a career in a visual-spatial area and/or an enjoyable life-long hobby.

If you would like to learn more about how to identify and develop your child’s strengths, I am happy to talk and can be reached at: devon@drdevon.com.

(Note: the pronouns “he” and “his” refer to children of any gender in this questionnaire)

  1. My child is good at forming 3D pictures in his head, and I believe he can manipulate them and move through them in his mind when he wants to.
  2. When my child draws, he likes to use 3D techniques like perspective or cutaways.
  3. My child likes it when teachers use pictures and diagrams to explain things rather than just words.
  4. My child is good at building things (e.g. Legos, K’NEX, marble runs, arts and crafts projects).
  5. When he plays a video game, it’s easy for my child to learn his way around the virtual environment.
  6. When my child puts together a kit (e.g., Legos, toys or models), he usually doesn’t have to read the written instructions. He can just tell how things must go together by looking at the pictures.
  7. After going someplace once, my child usually doesn’t need directions, a GPS, or a map to find it again.
  8.  My child would rather learn new information using pictures, diagrams, graphs, videos, or maps, instead of just reading or listening to words.
  9. When my child thinks through a problem, his thinking is often more non-verbal (visual images) than verbal (words).
  10. Before he can describe what he thinks about something, my child often has to translate his thoughts into words (up to that point, his reasoning process hasn’t used primarily words).
  11. My child likes learning about engineering, architecture, design, and physics.
  12. My child enjoys activities that involve moving through space in complex ways (e.g. sailing, flying, skiing, snowboarding, surfing, dance).
  13. My child is good at recalling 3D details about things or places he’s been, like how big things were or where they were in relation to each other.
  14. My child likes looking at 3D structures and figuring out how they work (e.g. engines, clocks, household appliances).