Dr. Devon MacEachron\'s Blog

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What is it? In 2006 Dr. Robert Melillo – a chiropractor – entered into a partnership with his nephew to launch the Brain Balance franchise model. Since then, over 130 franchises have been purchased across the country. The concept is based on Dr. Melillo’s book: Disconnected Kids: The Groundbreaking Brain Balance Program for Children with Autism, ADHD, Dyslexia, and Other Neurological Disorders. He describes his program as a “non-medical and drug-free approach” based on “cutting edge brain science” for achieving “optimum body and brain balance.” He argues that kids who have learning or behavioral issues have “inadequately developed sensory and motor systems” and because “the brain is built from the bottom up,” sensory and motor work must be done “before any higher learning, behavioral or academic changes can truly happen.”

He addresses this presumed deficit with “motor” exercises (e.g. rhythm and timing, primitive and postural reflexes, eye-muscle balance) and “sensory” exercises (e.g. hearing, vision, smell, taste, touch). Academic skills are also (briefly) addressed. The sensory, motor, and academic work is all condensed into 3 one-hour sessions per week at a center. Your child is taught by a “coach” – an unlicensed person who need have no background in education, health, occupational therapy, chiropractic, or any related field. A blogger who got details from a former center employee insider’s perspective reports that “most staff are very young (21/22 on average), with no real relevant qualifications, and there’s a high turnover; most don’t stay longer than a few months. That could be partly because of the wages; $10 an hour.”

In addition to the 3 hours per week your child gets at a center, the program includes nutritional recommendations and exercises to be done at home.

Most families are advised that their child requires two 3-month sessions at a cost of $6,000 per session, plus several hundred dollars for the assessment and proprietary nutritional supplements (including KidGenius vitamins “that help promote brain growth!”). Total cost is approximately $13-14,000. Cost per session works out to about $182/hour, of which the coach gets approximately $10. None of the cost is covered by health insurance.

Can it help? Let’s break the question down into what part (s) of it work, and for who?

Let’s start with “who.” I’m skeptical that children with all the different issues they claim to treat can be helped with the same basic treatment. A blog titled Total and Utter Neurobollocks states: “They claim to effectively treat pretty much any developmental disorder under the sun, including autism, ADHD, Asperger’s, Tourette’s and dyslexia, without the use of any drugs. This is because all these disorders are (apparently) caused by an “underlying functional imbalance or under-connectivity of electrical (brain) activity within and between the right and left sides of the brain.” Any alarm bells ringing yet? They should be. Whenever someone comes along with a miracle-cure for a range of unrelated conditions, and has come up with the equivalent of a Unified Field Theory of neurodevelopmental disorders, something must be a bit fishy.”

There are also multiple parts of “it” to consider – sensory motor exercises, academic skills tutoring, and dietary changes each would be expected to have different effects (if any). Some aspects of the program’s interventions might prove helpful to individual children. I’m all for good nutrition, academic skills tutoring, and parents spending quality time exercising with their children, for example. But there is no indication that the core theoretical basis of the program – that sensory-motor exercises will “balance” the brain and improve “functional connectivity” – has any basis in fact. That aspect of the program is based on speculation, not on credible evidence.

One parent, Natalie Hanson, chronicled her family’s experience in a blog. She wrote: “We went into it very hopeful.” “So…he’s a chiropractor. Whatever. If the program works, who cares?” Two years later she wrote: “many of you have reached out via the blog and via email for guidance about whether to pursue Brain Balance for your children. It’s so hard to hear your stories and your desperation, which (in many cases) mirrors our own.” But, “knowing what we know now, I don’t think we would do it again… The most valuable thing we’ve done is remove gluten and dairy from our kids’ diet, and get their genome mapped so that we can address underlying issues with their biochemistry through food, supplements, and ultimately medications.” Later that year she wrote: “I continue to get so many questions about Brain Balance from hopeful parents. I would just like to reiterate again that I WOULD NOT recommend investing in this program for your kids. It is extremely expensive, and the results are fleeting at best. You’re better off changing their food habits and finding other ways to address the behaviors. I know this may be unpopular for those of you looking for answers, but these programs are not what you’re looking for – what they are promising is, sadly, too good to be true.”

Dr. Harriet Hall, a retired family physician who writes about pseudoscience and questionable medical practices on the website Science-Based Medicine, wrote a critical review, saying she was initially skeptical because “miraculous results are reported (“He spoke for the first time!”),” but says the biggest red flag is that they claim their program is “clinically proven,” yet they provide mostly testimonials as evidence. Anecdotal reports do not provide evidence of the efficacy of a treatment. Dr. Hall examines the one research study then mentioned on the website in which “They speculate that ADHD is related to a “functional dysconnectivity,” hemispheric imbalance, subcortical dysfunction, a lack of temporal coherence, and a difference in arousal level between the hemispheres. They provide no evidence that these are characteristic of ADHD or were present in their subjects, or that their treatments specifically changed any of them. They assumed an underactive right hemisphere (it was not clear why) and they provided interventions that they assumed (without any supporting evidence) ought to remedy the alleged imbalance.”

When I checked the Brain Balance website for listings of research I found that several articles and a few studies are now listed. Some sound astonishingly compelling. A 2013 randomized control study (that part sounded good!) reports the “elimination of ADHD symptoms in 81% of participating children after completing a 12 week program.” As if that weren’t enough, 60% also achieved a two-grade level academic increase and 35% achieved a four grade level increase in academic skills! Sounds too good to be true, doesn’t it?

The lead author was Dr. Gary Leisman. I googled his name, and the fifth hit that shows up is a Finding of Scientific Misconduct published by the NIH in 1994. Apparently, this “authority” falsely claimed to have earned an M.D. degree he never earned, to have been a professor of neurology at Harvard Medical School (he had no such affiliation), and to have been awarded 13 U.S. Patents (he never was). Since that time, he has been working in Cuba and Israel.

Other articles include tenuous links to Brain Balance methodologies from some solid research findings. For example, the finding that children with autism have higher than normal connectivity between certain areas of the brain was extrapolated to “lend further support to the Brain Balance theory of Functional Disconnection…The Brain Balance Program combines customized sensory-motor and cognitive activities to repair the miscommunication.”

Why isn’t their more research? Well, first of all, neuroscience has moved far beyond the simple left brain/right brain dichotomy. Furthermore, the idea that diverse conditions are caused by a disconnection syndrome between the two hemispheres is preposterous enough to fail to get research funding.

Why don’t the people making money from Brain Balance programs fund some research? Melillo has argued that Brain Balance is too busy treating patients to do rigorous scientific studies. How convenient.

Can it hurt? Yes – your pocketbook.

What should parents do? Spend their time and money on treatments that are efficacious. Dietary changes, academic skills tutoring, exercise, and maybe even some sensory-motor therapy – depending on the child’s needs – provided by someone trained and licensed to provide it (a good occupational or physical therapist, for example).

I’ve been thinking about writing about pseudoscience and alternative therapies in the 2e world for some time, but worried about offending the usually well-meaning people providing such services and the often desperate families who choose to believe in them. But I’ve decided that in the current climate of fake facts it’s important to take a stand on the side of science.

I understand why alternative therapies can be appealing. Most are non-invasive, do not involve medication, and can sound logical intuitively. One hears anecdotes about how they changed a child’s life. Someone you trust and who seems to care may be recommending it. I get it. And I’ve been there myself as a parent, prepared to try anything and everything that had even a remote possibility of helping my child. But I wasted a lot of valuable time, energy, and money doing so. I hope you won’t make the same mistake.

So I’ll be writing a blog every two weeks in a series called: Myth Busters: Alternative Therapies for 2e Learners.

I’ll start with Vision Therapy.

I have to say it up-front. I’m astonished by how many people still think vision therapy can cure dyslexia. It simply can’t.

Let’s approach this logically from the perspective of where the breakdowns are cognitively in dyslexia. Dyslexia involves weaknesses in one or all of three brain processes: phonological processing, rapid naming, and orthographic processing. There is a great deal of evidence that the main mechanism is usually phonological, namely a basic defect in segmenting and manipulating the phoneme constituents of speech. This has nothing to do with vision. There is evidence (my PhD thesis was in this area) that rapid naming speed can be involved, as the dyslexic brain often has difficulty performing tasks requiring processing of brief stimuli in rapid temporal (time) succession. Again, this has nothing to do with vision. It has to do with timing. Orthographic processing is the formation of visual long-term memory representations of letters, letter patterns, and sequences of letters that serve to map spatially the temporal sequence of phonemes within words. In effect, it’s memorizing what letters and strings of letters look like (for example “ing”), and being able to identify them quickly and efficiently in a word. This does have to do with vision. But it’s a higher-level function. Figuring out what a word says is an iterative, interactive process drawing simultaneously on phonological, rapid naming, orthographic, and additional processes (e.g. word meanings or semantics). It involves higher level cortical functions. It occurs in the brain after visual signals are transmitted from the eyes. We know this from functional MRI’s of children reading.

Vision therapy addresses lower level ocular function. Its directed at improving visual acuity, eye tracking, ocular alignment, convergence, and other issues. For example, a series of convergence exercises may be recommended to treat convergence insufficiency, a condition in which the eyes are inefficient at working together when looking at nearby objects. This condition causes one eye to turn outward instead of inward with the other eye creating double or blurred vision. It affects between 0.1 and 5% of the population and is most common at high school or college age, when there is an increased demand for near work, and early middle age, when the use of bifocals leads to decreased accommodative convergence. Symptoms include eye strain and blurry vision. A younger child can have convergence insufficiency, and might complain of eye strain or blurry vision. Blurry vision would certainly make reading hard. But ocular function problems like this should not be confused with dyslexia.

When I took my dyslexic son to a vision therapist I was told he required 6-12 months of twice-weekly therapy for eye tracking due to frequency of eye saccades. Saccades are eye movements between two or more fixation points, for example backtracking and jumping ahead while reading. I later learned that a tendency toward frequent saccades is a symptom of, not a cause of dyslexia. When a dyslexic reader is having trouble decoding words, their eyes tend to go back and forth trying to figure things out more often than a non-dyslexic reader. So what my son needed was to learn how to read, not how to control his eye movements.

It is possible for a child to have both dyslexia and a lower-level ocular defect. But children with dyslexia are no more likely than any other child to have an ocular motor deficit. To automatically assume that a dyslexic child has an ocular motor deficit is a fallacy. And to assume that vision therapy can treat dyslexia is a fallacy too. The child who has dyslexia needs dyslexia remediation. The child who has both dyslexia and an ocular motor defect may benefit from vision therapy as well as proper remediation of his or her dyslexia. In that case I’d recommend doing dyslexia remediation first, then checking to see if the ocular motor defect is still there. But please don’t rely on vision therapy alone.

The strength of expert opinion against vision therapy for dyslexia is remarkably strong. My ophthalmologist has a binder in his waiting room full of articles refuting claims that vision therapy helps with dyslexia, ADHD, and other behavioral disorders. Key professional organizations have spoken out, issuing policy statements urging their members not to recommend it. The American Academy of Ophthalmology, the American Academy of Pediatrics, and the American Association for Pediatric Ophthalmology have issued joint statements, reaffirmed in 2014. Referring to dyslexia and ADHD, they state: “Scientific evidence does not support the efficacy of eye exercises, behavioral vision therapy, or special tinted filters or lenses for improving the long-term educational performance in these complex pediatric neurocognitive conditions. Diagnostic and treatment approaches that lack scientific evidence of efficacy, including eye exercises, behavioral vision therapy, or special tinted filters or lenses, are not endorsed and should not be recommended.” Even the professional association serving most of the optometrists who perform vision therapy, the American Optometric Association, has come out with the statement that: “vision therapy does not directly treat learning disabilities or dyslexia.” This is very clear-cut.

The preponderance of evidence and the consensus of experts point in the same direction. Vision therapy cannot cure dyslexia. I urge parents to prioritize evidence-based dyslexia remediation over vision therapy when deciding on treatments for their children.

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).

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.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.