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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.

I thought it would be helpful to post a list of the books and other resources I most frequently refer my clients to.

Books:

8 Keys to Parenting Children with ADHD by Cindy Goldrich (2015). Excellent “instruction manual” for how to parent children with ADHD including behavior management strategies. Author available for consultations.

Bright Kids Who Can’t Keep Up by Ellen Braaten and Brian Willoughby (2014). How slow processing speed impacts students and what can (and can’t) be done to help.

Executive Skills in Children and Adolescents by Peg Dawson and Richard Guare (2004). This is a manual – a “how-to” guide with specific interventions to be implemented at home and/or school for executive function weaknesses. I used this guide to help my son get through high school.

Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, bipolar, OCD, Asperger’s, depression, and other disorders, by James T. Webb, et al. (2005). In my view a bit extreme in suggesting that many behaviors characteristic of disability are actually just signs of giftedness, though I agree that does sometimes occur. I find that more often giftedness and disability coexist and that giftedness alone is not always (or even often) associated with dysfunction.

Overcoming Dyslexia by Sally Shaywitz (2003). Primarily about how to properly remediate reading problems but also specifically addresses challenges faced by bright dyslexics (Shaywitz is at Yale so discusses and works with students there).

The ADHD Explosion by Stephen P. Hinshaw and Richard Scheffle (2014). Chapters on the causes of ADHD (where biology meets culture) and diagnosing and treating ADHD are well worth the cost of the book. Much of the rest delves into social and educational policy issues. Anything by Stephen Hinshaw (one of my mentors at Berkeley) is recommended.

The Dyslexia Empowerment Plan by Ben Foss (2013). Focuses on strengths associated with dyslexia, explains assistive technology, and argues in favor of “reading” by listening rather than scanning text with one’s eyes. My son has taught himself to listen at 3x normal speed and says it is a “game changer” for him.

The Dyslexic Advantage by Brock and Fernette Eide (2011). Focuses on identifying the 4 main strengths associated with dyslexia. Powerful reading for adult dyslexics as well as parents. I give a copy to any parent of a dyslexic child who thinks they, too, might  be dyslexic. The book launched a foundation and website listed below.

The Mislabeled Child: How understanding your child’s unique learning style can open the door to success by Brock and Fernette Eide (2006). Covers misdiagnosis  and has chapters on different issues including communication challenges, ADHD, dysgraphia, dyslexia, and giftedness.

Websites, Facebook, and Other Resources:

2e Twice-Exceptional Newsletter. 2e Newsletter. An online bimonthly publication dedicated to understanding twice exceptional children. Modest fee for  online subscription. I think it’s well worth it.

Davidson Institute. Davidson Young Scholars. Non-profit providing free counseling to families of exceptionally gifted students accepted as Davidson Young Scholars. Many of my clients find the counseling to be very helpful.

Devon MacEachron, PhD. www.drdevon.com. That’s me! 2e assessment and educational advising. Facebook:  https://www.facebook.com/2Egifted/. Twitter: https://www.twitter.com/2egifted.

Dyslexic Advantage. Dyslexic Advantage Foundation. Focused on uncovering and celebrating the strengths associated with dyslexia. Testimonials, famous people, advice, assistive technology, etc. Premium membership gives access to a wonderful magazine and other resources.

Gifted Homeschoolers Forum. GHF. Primarily for families who are homeschooling, but much of the material and resources are of interest to all.  Publish articles, books, active online community, blog, ask the expert “column,” and have a section of their website devoted to twice-exceptionality.

Hoagies Gifted Website. Hoagies . Huge resource on giftedness and 2e with a plethora of articles, chat groups, blogs, etc.  Hoagies Gifted Discussion Group is a related Facebook group with 4,835 members you must apply to participate in.

Johns Hopkins Center for Talented Youth. CTY. Students testing as highly gifted in math or verbal qualify for their summer camps, online courses, family vacations, and day programs. The programs are not inexpensive, but they are phenomenal and can change a child’s life.

National Association for Gifted Children. NAGC. National advocacy group, posts articles, position papers, annual conference, offers Parenting for High Potential magazine, program and camp lists.

Parents of Twice Exceptional Children (2E): Closed Facebook group with 7,762 members you must apply to join. Active discussion with responses from parents in similar situations.

Raising Poppies: Closed Facebook group with 13,279 members you must apply to join focused on issues raising gifted children.

Twice Exceptional Children’s Advocacy (TECA): www.teca2e.org. Modest membership fee to access moderated online parent support groups, message board, and other specifically 2e resources.

TilT Parenting: www.tiltparenting.com. Features a weekly podcast focused on parenting 2e learners, referred to positively as “differently wired” kids, in the TilT manifesto.

I was asked to write an article on this topic for TECA (Twice Exceptional Children’s Advocacy), an online community providing service and program directories and information about advocacy. I decided to enlist the help of Benjamin Meyer, a therapist specializing in young adults with NVLD and Asperger’s in the workforce. Here’s what we wrote:

By Benjamin Meyer, LCSW and Dr. Devon MacEachron, PhD

You did it! Your child has finally received an acceptance letter to a college or university and is beginning his or her first steps toward adult life. All your hard work navigating the treacherous path of diagnosis, remediation, social skills training, OT, PT, gifted programming, IEP’s and 504’s has paid off. You deserve a lot of credit for all that you have done to guide your child through the process, and you certainly deserve to celebrate!

While high school has come to an end, it is important to keep in mind that even after college, your child may face challenges related to their disabilities. These can include identifying and finding a career they enjoy, adapting to the world of employment, making friends with peers, and adult dating. Many young adults with learning differences are unemployed or underemployed due to the more nuanced social and executive functioning demands of the workplace, The National Center for Learning Disabilities reports that only 46 percent of work-age adults with an LD are employed (Cortiella, 2014) . “Failure to launch” has become a national epidemic, with many young people returning home to live with their parents due to challenges with the professional and social demands of adulthood. Your high school grad will be at an advantage if they take a few practical steps while in college to prepare for the “real world”.

Young adults in our practices often identify specific challenges at work related to their learning profiles. The dyslexic who chose engineering or architecture due to his gifted visual-spatial skills may find that slow speed and miscalculations made in math problems hinders his ability to complete tasks efficiently. The ingenious marketing professional with ADHD may experience difficulty organizing her ideas into action plans. The gifted writer with Asperger’s Syndrome or NVLD may struggle to hold regular employment due to difficulties reading their peers’ body language. Young adults who plan in advance for a career or job that will be a good fit for their unique profiles are most likely to be successful transitioning to the world of work.

Finding the Sweet Spot

When deciding on a career, young adults can search for the “sweet spot” where their strengths, interests, and values coincide (see diagram). The blue circle represents strengths. These should include intellectual talents as well as people skills, executive function, willingness to work hard, artistic, musical, and any other abilities. The green circle encompasses interests: sports, outdoor activities, academic subjects – any and all interests the individual may have. Lastly, it is important to identify and “own” the personal values that can impact career satisfaction. These include: how important a flexible work schedule is, how much social interaction is desired at work, the hours one is willing to work, desire for autonomy and independence versus taking direction from a boss, whether one enjoys working on a team, being outdoors versus in an office building, how important a high salary is, how important it is have a high prestige position, whether one wants to be considered an expert or authority, how important it is to feel one is helping others or making the world a better place. Values go in the yellow circle. By identifying the key factors that influence career success and happiness, young adults can begin to see which careers might fall within their “sweet spot.”

Acknowledging and Factoring in Areas of Challenge

While students are searching for their “sweet spot,” they will also benefit from being honest with themselves about their challenges. There are certain skills that are important in practically any job. Relating to colleagues, keeping your emotions in check, taking initiative, and having an organizational system are a few of them. There are also specific skills required in different fields, e.g. math skills for an actuary or writing skills for a journalist. If the student feels they have a weakness in an area important to a career they feel they would like to pursue, they can work on developing those skills while still in college. For example, they might learn to create an organizational system with a coach or work with a therapist on professional social skills. The student will also benefit from consulting with professionals who are in the field they are considering, especially those who have a similar profile of strengths and weaknesses. This will help them assess how suited their specific strengths and weaknesses are with the demands of the job and will aid in identifying some strategies for compensating for their weaknesses. Internships and mentorships are ideal opportunities to practice compensation strategies while building on strengths, experience and expertise.

Case Studies

Jacob is a verbally gifted 2e student with nonverbal learning disability interested in becoming a social worker. He realizes that he may find meeting documentation requirements challenging due to executive functioning deficits, while also facing obstacles reading nuances in body language from colleagues and employers. On the other hand, his strengths in writing and verbal skills will help him to produce well-written progress notes and describe cases in detail. As is the case for any 2e student, expressing specific strengths to potential employers during and after the interview process is a critical skill for landing a good job. Twice-exceptional students have exceptional strengths and these can be a major attraction to employers. But prospective employers may not know what those are until the applicant articulates them in a clear and concise way, convincing the employer of their value. Jacob needs to sell his verbal and writing skills. At the same time, he should anticipate concerns about weaknesses and consider addressing them up front. If a prospective employer knows that Jacob has NVLD and what NVLD means, they might be concerned about Jacob’s organizational abilities. Jacob would be wise to highlight in the interview process that he worked on developing a unique filing system at his last job, and explain how this skill will help him be an effective social worker.

Neil is a brilliant mathematician and visual-spatial thinker with Asperger’s and ADHD. He struggled with attention and making friends in college, however he successfully identified a strong interest and talent in architecture. Neil knows that he will no longer have access to a note taker, extra-time on tests, and academic coaches to help him stay on task in the work world. Also, an understanding of business social skills will be critical for him to engage effectively with clients in this field. During his last two years of college, Neil decided to work with a therapist building business-savvy social skills. During the summer when he is interning at an architecture firm he intends to consult with a business organizational coach and mentor who understands some of the demands he is likely to face in an architecture career. When Neil interviews for full-time jobs after college he may request “reasonable accommodations” that will not create an excessive burden for the employer. These could include extra filing space, access to a computerized organizational system, and a co-worker to accompany Neil to organizational meetings and provide professional feedback, etc.

Caroline is a 2e student who is dyslexic and has ADHD. She wants to be a journalist. She hit some road-bumps along the way in college from her ADHD and as a result it took her 6 years to graduate. She’s decided she needs to address this up-front in her interviews by explaining that she has ADHD, what happened, and what she learned from it (e.g. how to be organized, how much she cares about learning). When she mentions her ADHD she intends to emphasize that she thinks it is part of the reason she is so creative as a journalist and point to examples of creative stories she has published. But she doesn’t think her dyslexia will negatively impact her future work because she knows to get her pieces edited for spelling and grammatical errors. So she’s not planning on mentioning that exceptionality.

Does Your 2e Learner Have to “Tell All?”

It depends. In an ideal, open-minded, accepting-of-neurodiversity world one would be up-front about such things. No one wants to end up in a position that’s a bad fit. On the other hand, although they legally cannot discriminate, prospective employers may be concerned about hiring someone who brings challenges along with them. Many people don’t know about twice-exceptionality and may not get that one can be gifted and have a disability. We recommend the student decide in advance how much information would be in their best interests to divulge. The decision of what to share may be influenced by how overt the student’s weaknesses are. If you can’t hide it, own it. The decision may be influenced by the culture in the specific career field or company. Technology firms and academia tend to be more open-minded to differently-wired people. Traditional businesses like manufacturing and law may be less so. Of course if the student does decide to share, thought should be given to how to frame such information in the most informative light.

When a 2e student is proactive in preparing for future employment during the college years, their chances of success are greatly improved. These steps can include: researching and selecting a career that fits well with their unique profile of strengths, challenges, and values; working to address organizational and “soft skills” deficits while still in college; and finally deciding what and how much to self-disclose. Although 2e young adults may face challenges adapting to the workforce, they can be proactive about creating strategies for overcoming these boundaries, especially if they start doing so during the college years.

Benjamin Meyer, LCSW is a bilingual psychotherapist who provides psychotherapy and coaching services to young adults with High-Functioning Autism and Nonverbal Learning Disorder post-college in New York City. Dr. Devon MacEachron, PhD is a psychologist with expertise in twice-exceptional learners who provides psychological assessment and educational planning services to children, young adults, and their families in New York City.

Works Cited

Cortiella, C. &. (2014). The State of Learning Disabilities: Facts Trends and Emerging Issues . New York, NY : The National Center for Learning Disabilities.