Dr. Devon MacEachron\'s Blog

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Where does the concept of overexcitability come from?

Overexcitability was introduced to psychology by Polish psychiatrist Kazimierz Dabrowski in the 1960’s as part of a “Theory of Positive Disintegration.” The theory proposed that psychological tension and anxiety are necessary to achieve the highest levels of personal and moral growth. Hence these “disintegrative” processes (tension and anxiety) were seen as “positive.” Dabrowski believed that some people have more “developmental potential” than others, and that high intelligence (giftedness) and overexcitability were predisposing factors.

So what exactly is overexcitability?

Dabrowski defined overexcitability as a heightened physiological experience of stimuli resulting from increased neuronal sensitivities that cause a person to experience life more intensely and to feel the extremes of joy and sorrow more profoundly. He called it a “tragic gift.”

He outlined five forms which have been elaborated by others over the years:

Psychomotor overexcitability manifests as a capacity for being active and energetic. It can include loving to move and being physically active, restlessness, speaking quickly, frequent impulsivity in action, and having high stamina.

Sensual overexcitability manifests as increased pleasure from the senses (e.g. tastes, smells, textures, sounds, and sights) and, conversely, extreme negative reactions to unpleasant sensations. It can include an exceptional dislike for particular stimuli or sensations, like the sensation of a shirt’s tag on one’s neck or the texture of certain foods.

Intellectual overexcitability manifests as an extreme desire to seek understanding, gain knowledge, and analyze and categorize information. It can include asking a lot of questions, being a quick thinker and observer, love of ideas and theoretical analysis, and the search for truth.

Imaginational overexcitability manifests as an intensified play of the imagination and vividness of imagery. It can include fantasizing, day-dreaming, a craving for novelty, and dramatization.

Emotional overexcitability manifests as a capacity for feeling emotions intensely and deeply. It can include being highly sensitive, empathetic, anxious, sad, lonely, nervous, fearful, having a heightened sense of responsibility, and a tendency toward self-examination.

What’s the link between giftedness and overexcitability?

Dąbrowski’s followers suggest that the gifted disproportionately display overexcitabilities, positive disintegration, and hence the potential to attain higher levels of personal and moral growth. The notion was popularized in the gifted education and research communities by Michael Piechowski initially in the 1970’s, Sal Mendaglio, who edited the book Dabrowski’s Theory of Positive Integration (2008), Susan Daniels and Michael Piechowski, who edited Living with Intensity (also published in 2008) and by Linda Silverman of the Gifted Development Center in Colorado, who worked with Piechowski and others on the development of the Overexcitability Questionnaire II, a self-report form widely used as a research instrument. You can try it out yourself by following the link.

I think parents find the concept appealing because it links giftedness and experiences and behaviors that could otherwise seem problematic or dysfunctional (like melt-downs over labels in clothes and extreme emotional reactivity), suggesting these are just part of the child’s gifted temperament. I personally found solace in the idea when my daughter was hypersensitive as a young child. However I have seen parents who take it to an extreme by attributing everything to only one aspect of their child’s profile (their giftedness), and ignoring areas of challenge that need to be addressed.

Is a link validated by the research?

I don’t think so. But I may get in trouble with my friends and colleagues in the gifted community for saying so. The idea that overexcitabilities are higher in the gifted has so captured the imagination and loyalty of researchers, practitioners, and parents that it has, in effect, become accepted as an article of faith or ideology. Practically every website and book written for parents on the social and emotional aspects of giftedness promulgates the view. There’s very little debate about it in the presentation to the public – it’s simply accepted as truth. That’s why I’m writing about it. It bothers me when everyone jumps on the same bandwagon without questioning where it’s going. Also, I have a problem with the idea that the gifted are more capable of attaining higher levels of moral and personal growth than the non-gifted.

Let’s look at the research literature:

On the “pro” side, in 1984 Colangelo and Piechowski summarized the literature, noting that overexcitabilities were consistently present in the gifted. Falk and Miller conducted a literature review of 28 studies in 2009, reporting that gifted individuals were significantly more overexcitable than the non-gifted, especially in the Emotional, Intellectual, and Imaginational areas. In Taiwan, Kuo and Chang (2013) concluded that gifted persons are significantly overexcitable. Many professionals involved in counseling the gifted (e.g. Linda Silverman, Ann Marie Roeper, Susan Daniels) have cited their personal professional experience as evidence that the gifted are more intense, sensitive, and overexcitable.

On the “con” side, in 2006 Mendaglio and Tillier conducted a literature review and concluded that gifted groups did not significantly outscore non-gifted groups. When Pyrt (2008) analyzed the effect sizes (strength) of the relationships reported in research studies he found most to be “small” and “trivial.” The only relationship that had a decent-sized effect was with Intellectual overexcitability. Jane Piirto, a researcher who’s made overexcitabilities her primary research focus, has administered the overexcitability questionnaire to over 600 gifted students, and who personally organized three of the first Dabrowski conferences in the U.S., was an “early adopter” but has grown skeptical over time. In an article titled “21 Years with Dabrowski Theory” she wrote that almost all the studies conducted have had small numbers of participants, making conclusions suspect, and that the only consistent finding has been for Intellectual overexcitability. A 2014 meta-analysis conducted by Daniel Winkler focused on answering the question: “Do the gifted have greater excitabilities than the non-gifted?” He did find a relationship between Intellectual overexcitability and giftedness. For the Emotional and Imaginational overexcitabilities he found that more studies failed to find a relationship than succeeded. The findings for Sensory overexcitability were deemed “insufficient.” And he reported that no studies conducted in the United States have found that the gifted have greater Psychomotor overexcitability.

I agree that the data indicates a link between giftedness and Intellectual overexcitability, but this doesn’t impress me.  I expected it. When you look for a relationship between two things that are conflated – like height and basketball prowess – you are likely to find one. The Big Five Factor Model of Personality, which has been strongly validated by the research, has a factor called “Openness” which is near identical to the concept of Intellectual overexcitability. Openness is the degree of intellectual curiosity that a person has. Of course it is associated with giftedness, and of course Intellectual overexcitability is associated with giftedness as well. As for the other excitabilities, it seems the evidence is just not there.

Why, then, is there such a strong ideology built up around this notion?

This makes me wonder why the gifted community has been so dogmatic about its belief in overexcitabilities, despite the lack of empirical evidence. It may be that people decided they liked the idea when it was just a hypothesis and haven’t kept up with the research findings. It was striking how fast thought-leaders in the gifted community jumped on the wagon when the hypothesis was first popularized in the 1980’s, despite a near total lack of any evidence at the time. I think it could also be due to the “halo effect.” Professionals in the gifted community want to see the people they work with through a positive lens. For parents, the idea that their child is oversensitive as part of their giftedness and that’s a good thing may be more appealing than an additional diagnosis of AHDH or Asperger’s or anxiety. Finally, we all want to think that pain and suffering will prove, in the long run, to be for the best. We want to believe it, and so we do.

Why does this matter, and what should parents do?

It matters because making the assumption that a gifted child is more excitable because they are gifted and that it’s fine (even good) to be that way can focus attention away from challenges that need to be addressed. Let’s remove the halo of giftedness, and look at the whole child. The potential for a child to realize their potential and to grow into a happy and productive (and personally and morally developed) member of society is increased when we support both their strengths and their weaknesses.

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

Books:

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

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

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

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

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

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

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

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

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

Websites, Facebook, and Other Resources:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Are you familiar with the 5 stages of grief?

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

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

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

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

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

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

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

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

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

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!