Dr. Devon MacEachron\'s Blog

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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.

The nature/nurture debate has been going on for centuries. Is it our genes (nature) that predict success? Or is it the environment (nurture)? In the past 20 years this topic has evolved into the innate ability/natural talent vs. practice/effort debate. One side argues that success is all about innate ability and natural talent, while the other argues that it’s all about how hard one is willing to work. In the early and mid-1900’s as researchers studied intelligence and developed tests to measure it, it was generally believed that one’s “natural endowments” predicted success. In the 1950’s and ’60’s the cold war space race was a boon for gifted education, as national polices were implemented in an effort to identify and educate the “best and the brightest.”

The pendulum swung hard from ability toward practice and effort in the 1980’s and 90’s. In a politically correct world, the practice/effort argument was appealing because it posits that anyone can achieve success if they are willing to work hard (and the right environmental factors are supplied). In 1993 Dr. Anders Ericsson published a paper arguing that training and deliberate practice could explain performance differences that had been previously ascribed to innate talent. Studying expert performance in sports, music, mathematics, and other areas he found that so-called innate ability was unnecessary to predict who would become most successful. The single greatest predictor of success was hours devoted to the activity. The more someone practiced, the better they were. It’s a provocative argument, and one that Ericsson still espouses over two decades later. If it’s true, anyone with any ability profile can follow their dreams and, with enough effort, reach them. Ericson did add one caveat: when it comes to athletics, height and body size do make a difference. Along the same line, in the book Talent is Overrated (2008), George Colvin argued that investing the right type of practice on a focused pursuit is far more important than natural ability in predicting performance. In 2011 Malcolm Gladwell popularized the “10,000 hour rule” in Outliers, attributing the success of the Beatles and Bill Gates almost entirely to intensive practice. 10,000 hours of practice was identified as the threshold level required to achieve the level of mastery associated with being a world-class expert in anything.

If this is true – that success is all about practice and effort, and that anyone can achieve anything they set their heart to – does giftedness as a construct even matter?

Recently, the pendulum has swung the other way – toward innate ability. In a 2014 meta-analysis, a study analyzing the results of 90 other studies carried out across disciplines ranging from sports to the arts to academia, authors Hambrick, et. al. reported: “More than 20 years ago, researchers proposed that individual differences in performance in such domains as music, sports, and games largely reflect individual differences in amount of deliberate practice, defined as engagement in structured activities created specifically to improve performance in a domain. This view is a frequent topic of popular-science writing—but is it supported by empirical evidence? To answer this question, we conducted a meta-analysis covering all major domains in which deliberate practice has been investigated. We found that deliberate practice explained 26% of the variance in performance for games, 21% for music, 18% for sports, 4% for education, and less than 1% for professions. We conclude that deliberate practice is important, but not as important as has been argued.” In  2017 authors Wai & Rindermann studied what factors contributed to high educational and occupational achievement by examining a sample of 11,745 high achievers across disciplines. They found that about 50% of these super successful individuals were in the top 1% in terms intellectual ability (in other words, they were gifted).

I agree that innate ability is important, and I don’t think all the practice in the world can take someone who has poor native ability to a level of super high achievement in most areas. But I also feel that innate ability alone is rarely enough.

What does it take to turn giftedness into success – for gifted children to become high achievers?  Giftedness is a raw ability. In his “Differentiated Model of Giftedness and Talent” Robert M. Gagné made an important distinction between natural abilities or giftedness and talents. He defined giftedness as: “the possession and use of untrained and spontaneously expressed natural abilities in at least one ability domain, to a degree placing that student in the top 10% of age peers.” Talent, on the other hand, implies “the superior mastery of systematically developed abilities (or expert skills) and knowledge in at least one field of human activity to a degree that places a student in the top 10% of peers in that field.” This is an important distinction because the terms “gifted” and “talented” are often used synonymously. Gagné differentiates between giftedness as raw capacity and talent as a developed ability. Talents progressively emerge from the transformation of high aptitudes into the well-trained and systematically developed skills characteristic of a particular field of human activity or performance.

Thus, a young child might be described as gifted to highlight that they have exceptional abilities and, when they have favorably developed these abilities may be described as gifted and talented. While such a child will always (barring exceptional mishap) remain gifted, only when a high level of performance has been attained can they also be described as talented. This alludes to the common phenomenon of gifted underachievement, and points us in the direction of beginning to understand and therefore remedy this.

Gagné’s model  illustrates the process and factors influencing whether a child’s giftedness will develop into a talent. Chance is a significant factor, but so are the environment and intrapersonal catalysts. Environmental influences include culture and family, teachers, peers, and the provision of programs and services. Intrapersonal catalysts include health, motivation, concentration, and temperament. Efforts can be made to facilitate the development of gifts into talents through a developmental process encompassing informal and formal learning and practice, enriched curriculum and training, a goal of challenging excellence, systemic and regular practice, regular and objective assessment of progress, and personalized accelerated pacing. Sounds like a great gifted education program to me!

So, to answer the question posed at the beginning of this blog: giftedness does matter. I feel that in many domains, it’s a necessary but not sufficient condition to predict high achievement. The development of gifts into talents is a process impacted by environmental, intrapersonal, and chance factors.

Let me add a caveat of my own that the discussion above focuses solely on the outcomes of “success,” “high achievement” and  “talent.” I believe it is quite possible for a gifted person to eschew such outward measures of achievement, and perhaps not contribute their talents to society at large in any measurable way, but to still be a happy and fulfilled person in part because of their giftedness. Giftedness can provide the individual with a rich inner life entirely separate from societal measures of success.

Ever since my mind-blowing trip to the Galapagos last January I’ve been thinking about evolution, the environment, and organism-environment interaction. Each island in the Galapagos has a slightly different environment, and the islands as a whole are very different from the Ecuadorean mainland. The animals who ended up flourishing on the islands adapted to their environment. Or they moved on.

I’m a psychologist, not an ecologist. The world I concern myself with is that of children and their development. But it occurs to me that we often don’t spend enough time thinking about that from an ecological perspective. An organism is an individual living animal, plant, or single-celled life form. A child is an “organism.” An environment is the surroundings or conditions in which a person, animal or plant lives or operates. School is an “environment.” The child and their school are part of an ecosystem, and they have important impacts on one another.

When something is not working well in the child-school ecosystem we often focus on what’s “wrong” with the child and why they don’t “fit in.” We sometimes pathologize the child’s behavior and diagnose ADHD, a learning disability, autism, or a behavioral disorder. The diagnosis may fit, but I often wonder whether the same child would be diagnosed with the same disability if they were in an environment better suited to them as an individual. Would the twice exceptional student who blurts out answers and won’t do what the teacher tells him to do be diagnosed with ADHD in a school where he could control his own pace of learning? Perhaps a move to a different environment would allow that particular organism – that child – to flourish.

I know that we often feel stuck with the school our child attends. We may have moved to a public school district specifically for the highly ranked schools. We may have gone through an onerous private school admission process to get a spot for our child at what we thought would be the best possible school. But sometimes it just isn’t working out and attention should be paid to not just the child and what might be “wrong” with him or her, but also to the environment and what might be “wrong” with it – for that child. The school your child attends may be perfectly fine for some children and even optimal for others. But it may not be the best fit for your child.

Many of us may have had the experience (I know I have) of spending our political capital in the principal’s office requesting a specific teacher because we heard from other parents how wonderful he or she was, only to discover that the teacher we begged for wasn’t so great for our child. Or discovering that although our daughter thrived at XYZ school, our son doesn’t. I don’t think one can always generalize and describe a school as a “good school” or a “bad school,” or a teacher as a “good teacher” or a “bad teacher.” Good for who? Bad for who?

Our children – the gifted, twice-exceptional, learning disabled, differently wired – are unique. They are organisms that need specific kinds of nutrients and environments in which to thrive. If your child isn’t developing optimally, it might be time to consider a change of environment. Optimal development happens when the organism/environment interaction promotes growth.

I realize that changing schools may not be convenient and can involve risks. But it might be among the best things you ever do for your child. I know parents who have made the sacrifice of moving to another state so their child could attend a better-fit school. And heroes who take on homeschooling. These parents have made bold decisions to try to find or create the best environment for their child to thrive.

When my son was 11 he begged me to not send him back to the school he had been attending. This was after spending the summer at two Johns Hopkins CTY camps (let this be a warning: it can be dangerous to let your child experience the joy of an optimal learning environment). We took him seriously, lost our deposit at his old school, and had to scramble to find a new school for him to attend. We ended up finding a small, funky, ‘”unschool” for gifted kids where I’m not sure he learned much, but he was happy. We call this his “first gap year.” He went on to do well at a wonderful middle school, high school, and the college of his choice. To this day he credits the finding of his academic and social “sea legs” to the “gap year” he had in the 6th grade. And he thanks us for listening to him.

I feel badly he had to ask.

Plato employed the maxim “know thyself” (“gnôthi sauton,“ translated as “come to know thyself” or “learn to know thyself”) in his dialogues at The Academy. He taught that knowing one’s self is a necessary first step in the pursuit of happiness. He believed that only when we truly know who and what we are can we pursue our true nature to happiness and fulfillment.

I’ve coined the term “Plato Parenting” based on this maxim. The idea is that parents can help their children discover, explore, and develop their true interests and nature to discover who they are.

But would this be helicopter parenting? Parents considering an active role in helping their children develop their interests may wonder whether this would constitute “pushing” (like a tiger mother) or “hovering” (like a helicopter parent). They may not know where they should fall on the spectrum from being more involved in the management of their children’s lives to less involved. It’s clear from an examination of the research literature that the most effective parents are those who are involved and responsive to their child and are authoritative and have high expectations. Parents who are disengaged and uninvolved are less effective. Parents who have low expectations and are permissive and indulgent are less effective. We’ve all seen this in action at the grocery store when a toddler throws a tantrum over candy, and a parent immediately gives in. And having low expectations tends to create a self-fulfilling prophecy. The most effective parents, when the goal is producing a happy, productive adult, are nurturing and responsive, yet they are also authoritative and have high expectations.

What do I mean by “authoritative” and “high expectations?” Some people confuse the terms authoritative and authoritarian. Authoritarian parents demand a sort of blind obedience from their children. That’s not good. Authoritative parents take a more moderate approach that emphasizes setting high standards and expectations, being nurturing and responsive, and showing respect for their children as independent, rational beings. High standards and expectations include instilling a strong work ethic, encouraging the productive use of time, and encouraging dedication to doing one’s best. Not all children are born with strong motivation, work ethic, and the knowledge of how to use their time productively to accomplish goals. Many if not most need to be taught these habits. Not only are children who are taught these skills more likely to be successful, but they’re also happier. Children, like adults, are happiest when they’re engaged in something they find interesting that provides opportunities for growth. In other words, when they’re pursuing their interests. They’re not happiest when they’re “hanging out” or wiling away the hours playing a video game because they can’t think of anything better to do. A growing body of scientific evidence indicates that pursuing one’s genuine interests toward a goal is highly correlated with happiness, as well as other positive traits such as increased concentration, self-esteem, and performance.

Don’t push your own interests on your child. When embarking on a program of helping your child identify and pursue his or her true interests, be careful not to fall into a trap of trying to influence your child to pursue what you are interested in. Carl Jung said: “Nothing has a stronger influence … on their children than the unlived life of the parent.” Often, when parents try to “craft” the perfect life for their child it bears an uncanny resemblance to the one they wish they’d had. We need to accept our child for who he or she is. If we don’t, and instead try to mold them into what we think they should be, one of two things will happen. Either they will accept our dreams and fail to develop their own, or they will rebel. Neither allows them to develop into their own true self, since one path involves blind acceptance and the other a rejection of the parent’s point of view. A psychiatrist I know in Palo Alto has a practice dominated by high-achieving Stanford grads who did everything they thought their parents wanted them to, realizing their parent’s dreams. But now – in their late 20’s and 30’s –  they’re unhappy and confused about what they want out of life.

So, how do you go about helping your child pursue his or her genuine interests? First, you need to identify them. Some children are “born” with strong interests, while others don’t seem to have any especially strong ones. I advise parents of young children to expose them to a wide variety of things – art, music, sports, theater, games, and academic disciplines. This should be done deliberately and methodically. Rather than taking your child on the same kinds of outings over and over, plan “field trips” to varied destinations. These can include museums, concerts, farms, zoos, animal rescue centers, hikes, bike rides, birding, the beach, Chinatown, Little Italy, historical sites, factory tours, a stock exchange, art galleries, a courtroom, science fairs, a geography bee, and fruit-picking. Read  books about a variety of topics. Talk about current events. Travel. Watch documentaries. Expand their horizons.

Observe your child’s reactions and reflect on them. Make note when your child seems intrigued by something. Think about why they are drawn to it, and consider what that might mean. If your child loves Legos, perhaps architecture or engineering would interest them. If your child loves playing outdoors, consider environmental studies. Try to keep an open mind and not be judgmental. Even activities that may seem unproductive can provide clues to worthwhile passions and future careers. The child who seems bossy and unyielding when playing with friends may crave leadership opportunities. The child who is on the phone chatting with friends about their problems all day may be drawn to psychology or counseling. When my daughter was young she loved to tell stories. As a teen she loved social media. Of course that worried me a bit. But now she’s an online news journalist. After exposing your child to a wide variety of things, as they near middle and high school, try to guide them toward selecting 2-4 interests to pursue more intensively to avoid the “jack of all trades, master of none” phenomenon.

Get involved and be proactive. Once you’ve identified your child’s interests the next step is to facilitate their pursuit. This is where being an involved parent comes into play. And having high expectations. Dedicate yourself to taking your child’s goals seriously and facilitating his or her achievements by bringing their goals within reach. Don’t just buy your child a trumpet. Find the best music instructors you can afford, structure time in the day for practice, sit with your child when they practice, and take them to concerts. It’s ok to actively help your child find opportunities. I know a parent who helped her marine biology obsessed child find a volunteer research internship at age 12 which led to her being co-author on a scientific paper at age 16.

What if my child doesn’t find a career out of this? It doesn’t matter. The young marine biologist who published at 16 went into an entirely different field. But she learned some very important things along the way. She learned how fulfilling it is to delve deeply into an interest, that one needs to work hard to accomplish something significant, that she could do practically anything she put her mind to, and that she didn’t actually want to be a research scientist!

By adopting “Plato Parenting” as a philosophy you can help your children develop into the happy, productive young adults they are meant to be. What better gift can you give your child than that?

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.

Intelligence is multifaceted. When people tell me they want to know their IQ, I feel like asking: “In what area?” There are many different cognitive abilities and they have different impacts on what one is trying to accomplish. That’s why I approach the assessment of a person’s abilities from the perspective of the Cattell-Horn-Carroll (CHC) model which is, in effect, an inventory of “the intelligences.” It’s the most comprehensive and empirically supported theory of the structure of cognitive abilities to date, reflecting 70 years of research. About 80 different abilities are defined, with 20-25 of these playing important roles in school learning.

What I’d like to talk about today is the future and the role fluid intelligence might have in it. In the CHC model there are basically two main groupings of abilities that represent higher-order reasoning: crystallized intelligence and fluid intelligence. They can be traced to two separate brain systems. Crystallized intelligence is a function of brain regions that involve the storage and usage of long-term memories, such as the hippocampus. Fluid intelligence involves the dorsolateral prefrontal cortex, the anterior cingulate cortex, and other systems related to attention and short-term memory.

Crystallized Intelligence is the ability to use learned knowledge and experience. It’s not the same thing as memory, but it does rely on accessing information from long-term memory (learning that has become “crystallized”). Crystallized intelligence encompasses vocabulary, depth and breadth of general knowledge, the ability to listen to and understand oral communications, knowledge of grammar, and the like. It is the product of educational and cultural experience. When you meet someone who has a large vocabulary, knows a lot of facts, is a Crossword puzzle or Scrabble master, and is a voracious reader, you can be pretty sure they have strong crystallized intelligence. People who have strong crystallized intelligence tend to sound really smart and they tend to do well in school.

In contrast, Fluid Intelligence is the capacity to reason and solve novel problems, independent of any knowledge from the past. It involves drawing inferences, concept formation, classification, generating and testing hypothesis, identifying relations, comprehending implications, problem solving, extrapolating, and transforming information. Fluid reasoning encompasses inductive reasoning, deductive reasoning, and quantitative reasoning. Sherlock-Holmes kind of thinking. When you meet someone who has strong fluid reasoning you may not have any idea how smart they are until you throw a problem at them that needs solving. People who have strong fluid intelligence don’t necessarily excel in school, especially in the lower grade levels. If they make it to the PhD-level they may have trouble memorizing all the information they need to pass their oral exams. But boy can they defend their dissertation!

Some of the children I work with are strong in both areas. Others are strong in one or the other, but not both. The ones with strong crystallized intelligence tend to do well in school, as so much of school (the way it is structured today) is about learning facts and procedures. The ones with strong fluid intelligence may be so busy questioning the assumptions that they don’t learn the rules and procedures their classmates do. They may resist authority and question the value of what’s taught in school.

The Future: Our world is changing very rapidly. I know people have often said that about the times they live in, but it’s more true now than ever before. The pace of innovation and disruption is accelerating. As a society we are facing all kinds of novel problems to which we have no learned solutions, from political changes to global warming to the potential dangers of artificial intelligence. By 2020, the Fourth Industrial Revolution will have brought us advanced robotics and autonomous transport, artificial intelligence and machine learning, advanced materials, biotechnology and genomics. I wonder: What kind of brains will our children need to work in that kind of environment?

Now I’m going to enter into an area of conjecture and hypothesis, as I can find very little research literature on the topic. I guess I’m tapping into my own fluid intelligence.

I think the minds that will be best-suited to solving the world’s problems in the future are those with strengths in fluid intelligence. I believe that individuals who rely on crystallized intelligence may look to the past and rely too much on book learning and facts and procedures. In contrast, individuals who rely on fluid intelligence will be able to think on their feet around something totally unfamiliar, and be comfortable with the kind of complexity, uncertainty, and ambiguity we’re facing. They will be flexible and fluid thinkers who like challenging the assumptions and thinking outside the box. Because many aspects of crystallized intelligence (e.g. stores of knowledge) can be easily accessed with a quick swipe on our phone, they may not be hampered by having weaker crystallized intelligence.

I feel a shift in the kind of intelligence we need for the future necessitates changes in the way we teach children. We’re teaching 19th century skills in our 21st century schools. To teach 21st and 22nd century skills will require a move away from the teaching of standard procedures and rote memorization toward creative problem-solving and how to tap into inductive and deductive reasoning processes. Intelligence is not fixed – it’s malleable. That’s what having a “growth mentality” is all about. So I’d like to see schools, parents, employers, and others focus more on the benefits of enhancing human fluid intelligence. After all, machines can probably do crystallized intelligence a lot better than we can anyway.

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!

Many parents wonder if their child will grow out of the problems that plague them as a child: their dyslexia, math disability, writing challenges, weak executive function, ADHD, or Asperger’s. I’m asked this question quite often by successful adults who are initially surprised their children are struggling, but when interviewed carefully about their own early years admit to having experienced similar challenges. But now they are a successful adult, so they must have grown out of it. Right?

Not necessarily. The short answer to whether most children grow out of these challenges is: probably not. At least not completely. But the demands in the world around them (their day-to-day environment) do change, and as they move through school and career they can be more selective about the kinds of things they choose to do, electing to do things they’re good at and avoiding things they’re not. So their dyslexia or ADHD or Asperger’s might not negatively impact the quality of their life very much as an adult, and may even become an advantage. But they still have it.

Adults diagnosed with dyslexia as children, even if they benefit from years of reading and writing remediation, tend to remain poor spellers and slow readers. I see this every day in my dyslexic husband who reads one book to my ten, though we spend the same amount of time reading every day.

For ADHD, some of the research suggests that children with ADHD simply have delayed brain maturation (by 3-5 years), but that they will eventually catch up with their peers. Unfortunately this may not happen until well past puberty and into college. I get dozens of calls every year from families of college freshmen with ADHD who are spinning out of control in the area of executive function. I often feel that students with ADHD would benefit from being “redshirted” to give their frontal lobe a chance to catch up with their peers’. Redshirting is a practice used most often in athletics of postponing entrance into kindergarten of age-eligible children in order to allow extra time for physical growth, making the children bigger and stronger thus more competitive athletically than their grade-peers. But it would be hard to “redshirt” our ADHD children for 3-5 years!

Anyway, rather than completely growing out of it, it seems that most children with ADHD grow up into adults with ADHD. The American Academy of Family Physicians reports that two-thirds of children with ADHD continue to grapple with symptoms (at some level) throughout adulthood. Their symptoms may present significant challenges, or they may not – depending on the circumstances. Some adults with ADHD only demonstrate impairing symptoms when they are anxious or depressed. Or when they’re hurrying. Or when they have to work on a long-term project. Or when they haven’t been getting enough exercise lately.

The environment and the individual’s physical state are both critical factors determining whether symptoms will be problematic or not. This is true for other medical conditions as well. If you have Type-II diabetes how you eat influences whether your symptoms manifest and whether your condition will appear to be dormant or you will have to use insulin for treatment. Adults with ADHD can try to choose careers (environments) that are well-suited to their needs. I can’t imagine either of my own children functioning very effectively if they were required to sit quietly at a desk all day doing routine work. Fortunately, they’ve gravitated to the fast-changing worlds of tech and media start-ups. In these environments they find it easy to stay attentive and focused. They can get up and move around. And they’ve learned that they’re more focused when they take care of their physical states by exercising, meditating, getting enough sleep, and eating right.

Children with Asperger’s still retain autistic brain differences as adults and gravitate to professions that fit their profiles. Hans Asperger wrote: “We can see in the autistic person, far more clearly than with any normal child, a predestination for a particular profession from earliest youth. A particular line of work often grows naturally out of their special abilities.” The adult with Asperger’s working as a physics professor or in Silicon Valley may be perceived as eccentric, but not necessarily as having a “disability.” The right environment can bring out the best aspects of a unique profile and downplay the worst.
Even during the school years, a child’s symptoms may manifest differently depending on the demands of the environment. A dyslexic child may experience significant challenges in elementary school when they have to read written text, hand-write responses, and are marked off for spelling errors. But when they’re in high school and can listen to text through voice software, type responses, and use spell-check, things can get a lot easier. A child with a math disability who struggles to recall math facts and has slow math calculation fluency may have a lot of trouble in elementary school when math is mostly about arithmetic. But when they reach high school and college when it’s more about problem-solving and fluid reasoning, they may excel.

So, children don’t usually grow out of it, but they may not be troubled by the different way their brain is wired when the demands of the environment change. In fact, having a differently wired brain may confer distinct advantages.

Books like: The Dyslexic Advantage: Unlocking the Hidden Potential of the Dyslexic Brain by Dr.’s Brock and Fernette Eide; The ADHD Advantage: What You Thought Was a Diagnosis May Be Your Greatest Strength, by Dale Archer, M.D.; and The Way I See It: A Personal Look at Autism & Asperger’s by Temple Grandin, M.D. point out the advantages that being wired differently can confer. This is not just “feel-good” pop-science – there is some serious research uncovering real strengths in thinking associated with each of these diagnoses.

If orange is the new black, maybe having a “disability” is the new superpower.