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Finally, some good news on “alternative” approaches to helping 2e learners! Thus far in the Myth Busters series I’ve panned vision therapy for dyslexia, The Amen Clinics for ADHD, essential oils for ADHD, and Brain Balance Centers for most anything. Now I turn my attention to the question of whether dietary changes can reduce ADHD symptoms, and find the answer can be “Yes!”

There are loads of studies showing a relationship between diet and ADHD symptoms. Of course poor diet and eating habits do not cause ADHD, but there is a connection between the kinds of foods children eat and their behavior and symptoms. This is true whether a child has ADHD or not, but may be even more true of children who have ADHD.

Why would this be the case?

Let’s look at the biology of ADHD. ADHD is caused by neurological, brain chemistry differences. There are millions of neurons densely packed into various regions of the brain, with each region responsible for particular functions (e.g. motor cortex, visual cortex). For the regions to do their jobs in a coordinated way they must link to other regions, with extensive “wiring” carrying information from one region to another along neural circuits or pathways. Information is transmitted along neural pathways via the action of neurotransmitters. Each neuron produces tiny quantities of different neurotransmitters that are released into the space that exists between neurons (called the synapse), stimulating the next cell in the pathway – and so on down the line. It’s kind of like a series of dominoes cascading down a line, but with the fall of each domino triggered individually.

In ADHD, there is a deficiency of one or more neurotransmitters in the brain. There are three subtypes of ADHD: inattentive type, hyperactive/impulsive type, and combined type. We believe that inattentive ADHD is linked primarily to deficiencies in the neurotransmitter norepinephrine, hyperactive-impulsive ADHD to deficiencies in dopamine, and the mixed type of ADHD with altered choline transporter genes. In addition, the emotional dysregulation (e.g. impulse control and aggression) aspect of ADHD is linked with a serotonin transporter gene.

How would different foods and nutrients affect ADHD brain chemistry? Let’s look at the main categories.

Bad Carbs and Sugar: The rate at which sugar from a particular food enters brain cells, and other cells of the body, is called the “glycemic index.” Foods with a high glycemic index (e.g. sugar and bad carbs like pastries) stimulate the pancreas to secrete high levels of insulin, which causes sugar to empty quickly from the blood into the cells. This gives the child a nice dopamine “rush” and may be one reason children with ADHD crave carbs and sugar – their bodies may (in effect) be trying to “self-medicate.” The rush of energy is, however, short-lived (1-2 hours). As blood sugar drops, the child plummets from peak energy to trough, and may get irritable, sleepy, and be less able to focus. Their body may crave more sugar to get the rush back. It can become quite a hormonal roller coaster. Plus ADHD and obesity are linked (probably though this process combined with weak impulse control) so you want to try to avoid letting your child get “addicted” to sugar and bad carbs.

Suggestion: Shift to foods that have a lower glycemic index. Say “yes” to most fruits and vegetables, beans, steel-cut oats, low-fat dairy foods, and nuts. Say “no” to candy, white bread, rice cakes, most crackers, bagels, cakes, doughnuts, croissants, and most packaged breakfast cereals.

Protein: Proteins affect brain performance by providing the amino acids from which neurotransmitters are made. Proteins also produce the amino acid tyrosine which, in turn, produces dopamine and norepinephrine – two areas of deficiency in ADHD. In addition, sugars from carbohydrates are digested more slowly when they’re consumed with protein, resulting in a more gradual and sustained blood sugar release.

Suggestion: Add plenty of protein to your child’s meals.

Iron: Since certain proteins (meat, fish) have the highest concentrations of heme iron, I’ll address iron next (if your child doesn’t eat meat or fish there are other sources). Iron is a cofactor for tyrosine, the rate-limiting enzyme of monoamine synthesis, so it regulates dopamine production. A 2017 review and meta-analysis of studies on ADHD and iron found that serum ferritin levels are lower in many children with ADHD than in healthy controls. For these children, iron supplements can improve ADHD symptoms.

Suggestion: Add more iron-rich foods to your child’s diet and/or consider giving an iron supplement. I advise that you do a ferritin test first to see if your child actually does have low iron before giving supplements.

Zinc: After brain cells release dopamine into the synapse, they “vacuum” it back up using a dopamine transporter. Zinc binds to the dopamine transporter and slows it down, allowing dopamine to remain active in the synapse for a longer period of time before being pulled back into the cell to be recycled. Thus, zinc is a natural dopamine reuptake inhibitor. Ritalin also inhibits the reuptake of dopamine (but less naturally). Lower levels of zinc have been reported in some children with ADHD. While I found a few solid studies that looked into the effects of zinc supplements, two showed improvement and two showed no effect. (1) I hypothesize that the children who benefited may have been those who had a zinc deficiency to start with.

Suggestion: Have your child’s zinc levels tested, and if they’re low, consider zinc supplements and/or adding zinc-rich foods to your child’s diet (red meat, poultry, pumpkin seeds, chickpeas).

Fatty Acids and Fish Oil: Omega-3 fatty acids have anti-inflammatory properties and can alter central nervous system cell membrane fluidity and phospholipid composition. Cell membrane fluidity can alter serotonin and dopamine neurotransmission. A thorough meta-analysis conducted in 2013 at Yale (2) found that “Omega-3 fatty acid supplementation demonstrated a small, but significant effect in improving ADHD symptoms.”

Suggestion: There’s modest potential for a benefit from giving your child fish oil.

Amino Acid Supplements: The amino acids phenylalanine, tyrosine and tryptophan are used to make the neurotransmitters dopamine, serotonin and norepinephrine. Among the few studies  examining how amino acid supplements affect ADHD symptoms, some show modest benefits, and some don’t show any. Amino acid supplements taken by mouth are considered to be “possibly safe” when taken on a short-term basis (up to 6 months) due to potential side effects including fatigue and loss of coordination.

Suggestion: Because of the risks and uncertainty of benefits from such supplements, go to the source and provide amino acids naturally through foods including: red meat, dairy products, whey, milk, soy proteins, chicken, fish, and eggs.

Elimination Diets: An elimination diet is a short-term eating plan that eliminates foods that may be causing allergies, sensitivities, or other digestive reactions – then reintroduces the foods one at a time in order to determine which foods are, and are not, well-tolerated. While it’s tough to implement this kind of strict, restrictive diet and closely monitor the results, the information gained can be helpful. The incidence of asthma, allergies, and skin infections appears to be higher among children with ADHD than those without. Children with food sensitivities can feel tired, itchy, nauseated, and have trouble focusing or difficulty controlling their emotions when they eat foods that don’t agree with them. Finding out which foods trigger these kinds of reactions and eliminating them can improve symptoms. Food dyes, milk, and gluten, are common culprits. The best synthesis of studies I found in this area is by one of my favorite ADHD researchers, Joel T. Nigg (3) He found statistically significant ADHD symptom reduction when children were given a narrow diet of foods unlikely to cause reactions.

Suggestion: If you suspect your child has food sensitivities and you have the discipline to test your hypothesis through an elimination diet, go for it!

In sum, I feel the evidence does suggest that dietary changes can help some children with ADHD symptoms. I’ve gotta say – that is one thing Brain Balance centers get right. But you don’t need to pay them over $10,000 to tell you that!

(1) Hariri, Mitra and Azadbakht, Leila. “Magnesium, Iron, and Zinc Supplementation for the Treatment of Attention Deficit Hyperactivity Disorder: A Systematic Review on the Recent Literature.” International Journal of Preventative Medicine, 2015: 6:83.

(2) Bloch, Michael H., and Qawasmi, Ahmad. “Omega-3 Fatty Acid Supplementation for the Treatment of Children with Attention-Deficit/Hyperactivity Disorder Symptomatology: Systematic Review and Meta-Analysis.” Journal American Academy Child Adolescent Psychiatry. 2011 Oct; 50(10): 991–1000.

(3) Nigg, Joel T., and Kathleen Holton. “Restriction and Elimination Diets in ADHD Treatment.” Child and Adolescent Psychiatric Clinics of North America, vol. 23, no. 4, 2014, pp. 937–953.

I’ve decided this series on alternative therapies will first tackle the mistakes I made myself as a parent. The last blog (Part 1) was on vision therapy as a cure for dyslexia. Today, in Part 2, I’ll address Dr. Daniel Amen’s Brain Clinics and how they purport to diagnose and cure ADHD.

Dr. Amen is larger than life. A media star, best-selling author of 30 books (5 New York Times bestsellers), producer of a t.v. show aired on PBS (or rather, infomercial) about his theories, paid motivational speaker, and master salesman promoting proprietary nutritional supplements.

He has 8 clinics in California, New York, Washington, D.C., Chicago, Atlanta, and Washington State. They claim to treat pretty much anything, from ADHD, addiction, anxiety and depression, autism, bipolar disorder, concussions, Lyme disease, marital conflict, dementia, and sleep disorders to weight loss. That claim alone should be enough to make anyone skeptical. Claiming to be an expert at everything is usually overreaching.

But let me zero in on how they “treat” ADHD.

I read Dr. Amen’s book: Healing ADD: The Breakthrough Program That Allows You to See and Heal the 6 Types of ADD when it came out in 2002. It sounded convincingly scientific. Neuroimaging was on the uptick and being heralded as a huge scientific breakthrough. Amen claimed he could cure ADHD by looking inside the brain with a single-photon emission computed tomography (SPECT) scan using gamma rays and with injected radioactive dye and tailoring treatment to 7 different types of ADD: Classic, Inattentive, Overfocused, Temporal Lobe, Limbic, Ring of Fire, and Anxious.

As my 2e son wasn’t responding to anything else we tried, the idea that he might have a specific subtype of ADHD that required a targeted treatment was appealing. So we paid a substantial fee and drove to an appointment at Dr. Amen’s first clinic in Northern California – somewhere in the Central Valley between San Francisco and Sacramento. We went through the intake process and were scheduled for SPECT scans. But something didn’t feel quite right, and I didn’t follow through. My response was instinctual at the time. But since then I’ve earned a PhD and reviewed the literature and scientific consensus from a more informed perspective.

First, there is no research evidence (other than what comes out of Amen’s presumably biased clinics) to support the idea that there are  seven different subtypes of ADHD. Real science – the kind backed by double blind studies, NIH supported grants, and published in reputable peer reviewed journals – has identified two types (Primarily Inattentive and Primarily Hyperactive/Impulsive). We’re kind of working on a possible third type tentatively called Sluggish Cognitive Tempo. There certainly is no such thing as “limbic” or “ring of fire” ADHD.

Second, to do a SPECT scan, the child must be injected with an IV carrying radioactive material directly into his or her bloodstream. Its radiation-emitting particles are carried to every part of their growing body. There is an increase in the possibility of cancer being caused as a result of this kind of radiation exposure, particularly for children, as their growth means more cells are dividing, providing a greater risk of radiation disrupting cell development. This is why they ask you if you’re pregnant before giving you a mammogram. The risk may be small, but it’s there.

Third, the idea that you can diagnose ADHD by looking at SPECT images of blood flow in the brain is a huge leap of faith. The key question in evaluating a diagnostic test is whether or not its findings are useful in determining what treatment the patient should have. SPECT scans are not FDA-approved for diagnostics, partly because they only have a 54 percent  sensitivity, meaning they are only accurate half the time. Scientists have yet to identify reliable diagnostic markers using far more advanced technologies such as fMRIs, which provides better temporal and spatial resolution. There is no scientific evidence to suggest that SPECT scans are a useful diagnostic tool for ADHD and can inform treatment plans. The American Psychological Association has twice issued papers that dispute “claims being made that brain imaging technology … is useful for making a clinical diagnosis and for helping in treatment selections.” The most recent paper was the work of 12 scientists who spent three years assessing the latest research. The summary: “There are currently no brain imaging biomarkers that are currently clinically useful for any diagnostic category in psychiatry.”

None of the nation’s most prestigious medical organizations  — including the American Psychological Association, the National Institute of Mental Health, the American College of Radiology, the Society of Nuclear Medicine and Molecular Imaging, and the National Alliance on Mental Illness — validate his claims. Literally no major research institution takes his SPECT work seriously.

Here in New York, the extremely well-respected APA president and chairman of Psychiatry at Columbia University, Dr. Jeffrey Lieberman, says: “In my opinion, what he’s doing is the modern equivalent of phrenology…The claims he makes are not supported by reliable science, and one has to be skeptical about his motivation.” Former director of the National Institute of Mental Health, President of the Society for Neuroscience (the leading professional organization for neuroscientists), and director of the Center for Psychiatric Research at MIT and Harvard, Dr. Steven E. Hyman, says: “I can’t imagine clinical decisions being guided by an imaging test.” Dr. Thomas Insel, director of the National Institute for Mental Health, says “entrepreneurial zeal capitalizing on scientific advances needs to be tempered by reality checks.”

Dr. Amen thinks he’s a “maverick” onto something that no one else in the field understands. I guess I might respect that (I do like mavericks) if he weren’t a self-promoter making a ton of money by preying on the fears and hopes of desperate families using invasive, potentially dangerous, and ineffective technology. Don’t be fooled by his brand of pseudoscience.

When interviewing parents about their child’s strengths and weaknesses, I often hear statements like the following: “I don’t think my child has a problem with attention – he can focus really intensely on his cartoon-drawing (or video-gaming or Lego-building or reading) for hours at a time! In fact I can barely get him to stop. But his teachers complain he’s inattentive and distracted in the classroom. Maybe he’s just not stimulated by the material being taught?” Does this sound like your child – or one you know?

Some of the questions I need to help answer are: Is the child gifted? Does the child have ADHD? Is the child gifted and does he or she also have ADHD (i.e. is twice-exceptional)? Which of these factors are impacting the child’s ability to thrive in and outside of school? And what can be done to help.

My friends Xavier Castellanos, MD and Felice Kauffman, PhD wrote a monograph for the National Research Center for the Gifted and Talented on this very topic. It is reproduced here in short form on SENG’s website. They note that “Some people erroneously assume that a child who demonstrates sustained attention, such as a gifted child engaged in a high-interest activity, cannot have ADHD. It is understandable that an observer might discount the possibility of ADHD because from all appearances the child is so absorbed in a task that other stimuli fade into oblivion.”

While in fact: “This state of rapt attention can be described as “hyperfocus,” a condition that individuals with ADHD frequently experience.” Hyperfocus is the tendency for children and adults with ADHD to focus very intensely on things that interest them. At times, the focus is so strong that they become oblivious to the world around them. For more on hyperfocus see an article from Additude magazine here. Felice and Xavier point out that: “Activities that are continuously reinforcing and “automatic,” such as video or computer games or reading for pleasure, do not distinguish children who have ADHD from children who do not have ADHD, whereas effortful tasks do.” So it’s not whether the child can focus – it’s whether they can focus on effortful tasks.

They continue: “Evidence suggests that the gifted child with ADHD is particularly predisposed to exhibit this state of “hyperfocus.” While this can be a positive aspect of task commitment, it becomes a problem when the child is asked to shift from one task to another.”

Does this scenario sound familiar? You ask your child to stop doing what he is hyper focused on and come to dinner and he ignores you or objects strenuously?

Xavier and Felice write: “While cognitively this state (hyperfocus) can have positive aspects, behaviorally it can cause problems. It is important to understand that ADHD is not characterized by an inability to sustain attention, but rather by the inability to appropriately regulate the application of attention to tasks that are not intrinsically rewarding and/or that require effort. Such tasks are, sadly, characteristic of much of the work that is typically required in school, even in programs for gifted students.” So if school isn’t intrinsically rewarding, interesting, and/or requires effort, the gifted child with ADHD may tune-out and turn off.

To complicate matters, “By virtue of their giftedness, the range of tasks that are perceived as “effortless” is broader for gifted children, which is why their ADHD may be less apparent than in children who struggle more obviously and to lesser effect.” Something that would be effortful for a typical child (e.g. understanding a new math concept or comprehending sophisticated text) might not be effortful for the gifted child to whom such things come easily. So when a gifted child does have ADHD, their teachers may under-report symptoms because they appear to breeze through so much of the material. I see this most often when the child happens to be likable and internalizes rather than externalizes their frustrations.

It can take an assessment by a psychologist experienced in working with gifted and twice exceptional learners to tease out the subtleties.

It’s important to find out what’s going on because the student may be under-performing, or may be losing confidence and self-esteem. Their over-reliance on strengths to get by may “inadvertently obscure the disability.” They may get B+’s by answering questions based on superior reasoning skills, not necessarily having learned the actual material being tested. They may be frustrated and grow to distrust their abilities because they realize (consciously, or subconsciously) that they have to struggle to maintain them. They may feel they aren’t very smart after all. There may be negative impacts outside of academics: socially, emotionally, with friendships, and within the family dynamics.

When the student is accurately diagnosed, he or she can be given the opportunity to learn appropriate compensatory and coping skills. It’s especially helpful to address these issues at an early enough age before the student has turned off school, become a behavioral problem, become the class clown, or internalized frustrations in the form of anxiety or depression. While an adult can (if lucky) be happy and successful intensely pursuing their interests, few achieve success and satisfaction if they are unable to push through the less rewarding phases of an activity and keep working when something becomes effortful. These are skills and mind-sets we need to teach our twice exceptional children who are gifted and have ADHD.

If I can help you ascertain whether your child is gifted, has ADHD, or both, reach out to me at dm@drdevon.com. I do not charge for an initial 60 minute conversation.

There’s a big gap between how ADHD should be diagnosed and treated and what too often happens in the real world. Far better outcomes would occur if we avoided these pitfalls and did it right. Here’s what I see as the five mistakes that are often made:

1. Cursory evaluation. While it’s tempting to just examine whether the child has ADHD, often there are complicating factors arguing in favor of a comprehensive evaluation. The child might be inattentive because he or she is gifted, has dyslexia, is depressed, has a growth disorder, or a multitude of other factors. If these alternatives remain unexamined we may never know if the child actually does have ADHD, or whether another problem is the real cause of their symptoms. Even if the child does have ADHD a failure to identify commonly accompanying conditions leaves those challenges unaddressed. Comorbidity is the coexistence of physical or psychological challenges. ADHD and dyslexia are comorbid in 25 to 40% of cases, ADHD and depression in 20% to 30%, and ADHD and anxiety in more than 25% of cases. For autism, comorbidity rates with ADHD range from 37% to 85%. So I’m a big advocate of comprehensive evaluation.

Even when an evaluation focuses solely on whether the child has ADHD, it is often too limited in scope. I see this most often when a general pediatrician who has not received much training in ADHD bases a diagnosis entirely on two 10-minute forms: one filled out by a parent and one by a teacher. A lot of children are put on ADHD medications based on just this sort of brief evaluation. A proper ADHD evaluation should include at least: a thorough developmental history; parallel behavior rating scales filled out by multiple reporters at home, school, and self-report; neuropsychological tests of attention performed in an office; observations of parent-child interaction and child behavior; and – optimally – classroom observations.

2. Willing the results to go one way or another. Since a good chunk of the information contributing to an ADHD diagnosis comes from parent and teacher reports of behaviors they feel they observe, bias and perspective can come into play. Often I see teacher reports weighing strongly in favor of a diagnosis and parent reports suggesting there is no problem whatsoever. Or the opposite. Or a father who sees no symptoms and a mother who sees many. As beauty is in the eyes of the beholder, so is ADHD. A highly structured teacher who values control and compliance may be more likely to see a child’s behaviors as indicative of ADHD than a permissive, creative teacher who values spontaneity. Sometimes parents or teachers are eager for a “quick fix” in the form of a “magic pill.” Sometimes teens or young adults want an ADHD diagnosis to get their hands on a pill they feel may give them a leg up in the competition for good grades and college admissions. Sometimes parents are reluctant to have their child given a potentially stigmatizing diagnosis. A good evaluator needs to see beyond these motivations.

3. Pursuing treatments that have no (or very little) scientific evidence to support their effectiveness. I can’t begin to tell you how often well-meaning parents are drawn to alternative, untested therapies that have little or no scientific evidence of effectiveness. These include neurofeedback, CogMed, acupuncture, special diets, fish oil, and the like. I understand why parents do this. They are hoping for a solution that avoids medication. But the majority of these approaches are not evidence-based (there is no scientific evidence to suggest that they actually do any good). Most will do no harm, but a lot of time and money can be wasted. The “evidence” that does exist supporting many of these approaches is purely anecdotal and there may be a placebo effect at play. I don’t work for the pharmacology industry and I have no vested interest in reporting that the scientific evidence, over 75 years of research, indicates that stimulant medication is effective at improving concentration and reducing impulsivity and lack of control in 80% of individuals with ADHD.

4. Not taking the time to carefully trial type and dosage of medication. When a family decides to try medication, too often the prescribing doctor doesn’t take the time to carefully trial the different types of medication available and find the best dosage for that particular child. It’s not a “one size fits all” science, and there is no way to predict in advance which medication and what dosage will work best. Sometimes a 160 pound teenager needs less than a 6-year old. Sometimes an amphetamine like Adderall is better than a methylphenidate like Ritalin. Sometimes short-acting formulations are better than long-lasting. What should happen is a careful trial of several different dosage levels and different medications with feedback from parents, teachers, and the child on effectiveness. Far too many clinicians fail to take the time to do this. Even when an optimal medication is found, it’s important to continue with regular, ongoing evaluations of its effects and monitor changes over time.

5. Failing to also implement behavioral interventions. While medication certainly can help it can’t solve everything. A child with ADHD usually doesn’t have the same kinds of intrinsic motivation for task completion and performance as others. Regular, consistently delivered rewards (and punishments) may be needed in the classroom and at home to optimize performance. Clinically-administered behavioral therapy and/or social skills training may be needed. For older children cognitive behavioral therapy can have real benefits. Parent training can be very helpful for learning how best to manage the child’s behavior.

I urge my clients to take the time to do it right. Get a good evaluation, try to be impartial about the results, be scientific about the treatments you pursue, and realize that a pill can’t fix everything.

And in the midst of all this please don’t forget to focus on your child’s strengths (see my blog titled  Top 10 ADHD Superpowers).

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).