Dr. Devon MacEachron\'s Blog

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Are you familiar with the 5 stages of grief?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I recently had the pleasure of being interviewed by Debbie Reber, founder of TiLT Parenting, an online destination with a blog and weekly podcasts on parenting “differently wired” kids. Our podcast interview was on assessing and supporting twice-exceptional learners.

TiLT is a terrific resource. Recent podcast topics include: Using a Strengths-Based Approach to Support Differently-Wired Kids and The Connection between Creativity and Neurodiversity. Debbie is a New York Times bestselling author, life-coach, and speaker who worked in children’s television before she moved with her family to Amsterdam where she home-schools her son, Asher. She’s a mom-blogger/website doyenne with a highly professional approach. But what I find most impressive about Debbie is her story, her courage, and how her attitude developed into the philosophy that guides TiLT.

Debbie reacted to the frustrations, stress, and challenges of raising her 2e child by deciding to radically shift her parenting attitude and her family’s experience.

Like many of us, she started down the parenting road with no idea she’d soon have a lot more to handle than she’d expected. A year of colic followed by an intense and strong-willed toddler-hood, with regular notes home from preschool teachers about problems, made Debbie and her husband begin to wonder what was going on.

I love this paragraph about her son at age two:

By his second birthday, our little guy was regularly turning heads, both with his ridiculous vocabulary and his apocalyptic conniptions. Anyone who spent any time with Asher couldn’t help but notice that he talked in complex sentences pretty much nonstop. And the tantrums? They just seemed somehow bigger than typical toddler fare. When other parents witnessed an Asher tantrum go down, I’d see shock and awe in their eyes.

For the next four years they scrambled to find a school fit (three schools in three years) while they pursued one evaluation after another. The conflicting labels left them more confused than ever. They piled on the support, only to find little in the way of improvement. Meanwhile Debbie was growing increasingly frustrated, isolated, and struggled with “a fierce sense of personal incompetence, guilt, and failure.”

A realization that this just wasn’t working for their family was well-timed with a move abroad. This provided the opportunity to start over with a different approach. Debbie and her husband decided to: “toss out everything we thought we knew about parenting and education and forge our own path.” Their home-school adventure began.

Debbie realized in the first few months that her biggest source of conflict was with her own thinking about what her life as a mom should be like. She still struggled with occasional feelings of jealousy of friends who were raising “normal kids,” and still worried about her son’s future, but gradually her thinking changed from what she thought her life as a mom should look like to what her momhood could look like.

Debbie’s family is thriving. Now, she’s “on a mission to change the experience we as parents have in raising these kids so that they can go through their lives and interact with the world around them in a way that will help them thrive.” Her philosophy is summed up in the TiLT Manifesto which proposes “a new parenting paradigm, one that embraces difference and uniqueness in children, says no to fear and guilt and isolation, and celebrates and supports our kids, and us, in our experience.”

What’s the take home message? Parents of children who are different can make a conscious decision to stop trying to parent the child they thought and dreamed they would have and instead parent the child they do have. It’s hard, because we all have expectations about what parenting will bring and it’s tough to let that image go. It takes a lot of courage to accept that what might be best for your family is to reject what everyone else is doing. Forget about traditional school and team sports. Stop trying to “fix” your child and help them fit in and instead try to change your child’s environment to fit them.

Debbie is an inspiration. We can’t all move overseas and home-school like Debbie does, but there is wisdom to be gained from her story and great information on her website. Check it out.

 

Back in the last century and through the early 1900’s researchers operated under the assumption that intelligence was a uni-dimensional construct. You were either smart, or you weren’t. And how smart you were could be measured with one test resulting in one number: IQ.

In the 1970’s a shift began away from the IQ construct. Gardener argued in his Theory of Multiple Intelligences that there were up to ten kinds of ability: musical-rhythmic, visual-spatial, verbal-linguistic, logical-mathematical, bodily-kinesthetic, interpersonal, intrapersonal, naturalistic, existential, and moral. Sternberg proposed practical, creative, and analytical intelligences. Daniel Goleman popularized the notion of emotional intelligence, or EQ. While these theories add considerably to our understanding of broader abilities and what it takes to be a happy and successful person, I’d like to focus in this blog on the kinds of mental abilities required to reason, solve problems, think abstractly, and comprehend complex ideas. What I’d call “intellectual abilities.”

Research has advanced to the point where we probably know more about the underlying cognitive and brain processes involved in mental abilities and intelligence than any other complex psychological construct. Click here for more information on this concept. The consensus is that the most useful and descriptive model of intelligences is the Cattell-Horn-Carroll (CHC) Model. This model has become so prevalent that nearly all modern IQ tests have been changed to incorporate the theory as their foundation.

I find the CHC model to be a very useful framework for understanding individual student’s ability profiles and how they impact learning –how they are intelligent.

The CHC model identifies over 80 different cognitive abilities. About 30-40 of these are important in school learning and achievement. The others, like “musical discrimination and judgment,” aren’t as directly related to academic achievement.

It is a fact that most of us have uneven profiles of strengths and weaknesses across these 30-40 abilities. Let me illustrate the concept. But instead of showing all 30-40 school-related abilities, I’ll illustrate the point with 11 of the more important ones (e.g. verbal reasoning, listening ability, inductive and deductive reasoning, aspects of memory,  processing speed).

The stereotype of a highly intelligent, gifted child is that they are good at everything. If they were, one would expect to see a profile like the graph below – all abilities would be in the highest ranges.

I rarely see a uniform profile like this, even among highly and profoundly gifted learners. Most gifted students are not equally gifted at everything. They may have some abilities in the average range and even some in the well below-average ranges.

The flip side of the gifted stereotype is the learning disabled stereotype. This stereotype holds that students with learning disabilities are bad at everything academic/intellectual. A student who is weak in all of the cognitive ability areas contributing to academic learning would be expected to have a flat profile with low scores in all areas.

I have never seen a student with learning disabilities with a flat profile like this. Students with learning disabilities, by definition, have areas of cognitive strength. They are not bad at everything. But when I ask students who are having difficulty at school what they think their profile looks like, many think it looks like the graph above. They’ve lost sight of their strengths (if they ever knew they had them). They tend to think they’re “bad at school” and maybe even “not too smart.”

In reality, very few people are good at everything or bad at everything. Most of us have uneven profiles with strengths in some areas and weaknesses in others – more like the chart below. Terms like “gifted” and “learning disabled” are too vague to describe these variations. Gifted at what ability? How gifted in that specific ability area? Learning disabled at what? How learning disabled in that specific ability area?

From a practical standpoint what’s important is to understand where the student’s strengths and weaknesses are, and how to work with them. How they’re intelligent.

Recently I worked with a boy whose parents and teachers felt he was not achieving his potential in school, and wondered if he might have ADHD or a learning disability. Zack was a hard-working and motivated student who was engaged in class, diligently turned in his homework, and studied hard for tests. He tended to get great marks during the semester but couldn’t seem to break a “C” on tests and exams. My assessment ascertained that he didn’t have ADHD or a learning disability, and he had a nice solid IQ at the 90th percentile. But he had a surprising weakness in long-term auditory memory. This explained his underperformance – he wasn’t consolidating learning efficiently into long-term memory so he couldn’t efficiently retrieve what he had learned for tests and exams. The good news for Zack and his family was that this is quite fixable. One can get better at memorizing and storing information. We came up with a tutoring plan to build his ability utilizing his stronger visual memory and fluid reasoning.

An understanding of how the student is intelligent can be helpful to any child (like Zack, who it turned out was neither learning disabled nor gifted, but had an area of weakness that needed to be addressed). But it is especially important for twice-exceptional learners. The discrepancies between the twice-exceptional student’s strengths and weaknesses are more extreme than they are for most people. This unevenness of abilities causes considerable frustration. A 2E student may have very strong vocabulary and verbal reasoning, and excellent listening ability and fluid reasoning (inductive and deductive thinking), but their weaknesses in ability areas like phonetic coding and naming speed may severely inhibit their ability to read and demonstrate what they know in writing. In other words, they may be dyslexic. Or they may have extremely high quantitative reasoning and visual spatial ability yet be unable to reliably process information quickly and efficiently due to slow processing speed. An in-depth assessment of cognitive strengths and weaknesses is a very important step in figuring out how to help such students achieve their considerable potential.

The term twice exceptional, sometimes shortened to “2-E,” is being used more and more often to describe high-ability learners who also have learning difficulties. These are smart students who have dyslexia, ADHD, Asperger’s, or some other learning weakness or disability that gets in the way, at times, of their ability to learn and perform at their ability level. It’s a terribly frustrating situation for all involved!

The word “exceptional” is used because it communicates the idea that these students have abilities at the extreme end of a range. Exceptional by definition means uncommon, deviating widely from the norm.

The word “twice” refers to the exceptionalities being in two areas: one in an area of strength and the other in an area of weakness. Jason, who has verbal ability at the 99th percentile yet cannot not read or spell anywhere near grade level due to his dyslexia is twice-exceptional. Melissa, a science and technology whiz who knows seemingly everything one could possibly know about cell phones and satellites, yet can’t connect well with others due to her Asperger’s, is also 2-E.

But thinking of a student as just twice-exceptional is often an oversimplification. Many students have more than one area of significant strength and more than one area of significant weakness within their cognitive profile. They are not just twice-exceptional, but rather thrice or more! This happens because both strengths and weaknesses tend to occur in clusters (known as co-morbidities in disability jargon).

Just taking ADHD, it is estimated that 50-90% of people who have ADHD also have some other weakness/disability such as a learning disability, anxiety, depression, or bipolar. And this is the same for strengths – it is quite common for a 2-E student to have strengths in more than one area. Sarah has four areas of weakness: ADHD, dyslexia, math disability and anxiety. But she has three gifted-level strengths: verbal reasoning, fluid reasoning, and creativity. Among the students I’ve assessed there are many more children like Sarah who have multiple exceptionalities on both sides of the equation than who have just two.

Does a student have to be identified as “gifted” to be twice-exceptional?

I feel it depends on what one means by “gifted.” Global measures of intelligence like IQ are composites of many different abilities including verbal, visual-spatial, fluid reasoning, memory, processing speed and other abilities. 2-E learners might not test as globally gifted because their areas of weakness can bring down their overall IQ score. Yet they still have significant (exceptional) areas of strength. I consider a student to be gifted – to be “exceptional”- if they have a significant strength in one cognitive area related to learning and higher-order reasoning. They don’t need to be “globally gifted” and good at everything to be gifted in my book. I certainly consider a student who is exceptionally strong at higher order math thinking and fluid reasoning yet makes frequent careless errors and has slow math fluency to be gifted. In fact that profile describes the kind of “arithmetic weak/math talented” sort of student who may be in remedial math in lower grades, yet is capable of excelling in higher level math classes in high school and college math ld.

How “disabled” does a bright student need to be to be twice-exceptional?

Just how weak do their weaknesses need to be? Some academicians, educators, and others feel that unless a student is performing below the average level of his/her peers (and this can be defined as low as the 25th percentile), they do not have a disability. I disagree, and so do many professionals who have experience with gifted learners. Students are expected to perform academically at their ability level. That is what IQ tests were originally designed to do: predict academic performance based on ability. If there is a significant gap between ability and achievement, that’s a problem that needs to be addressed.

Twice-exceptional learners are complex and fascinating. They have enormous potential, but it may be hidden from view. Underachievement is a high risk. Frustration is a given. Anxiety and depression are common side-effects.

If you think your child might be twice-exceptional, one of the greatest gifts you can give them is of understanding.