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Breaking News! Full Scale IQ is out for identifying 2e students as gifted! Measures that capture their strengths better are in!

What is the WISC-V? The most common IQ test most of us use to assess intelligence is the Wechsler Intelligence Scale for Children (WISC). It was first published in 1949 and is updated about every 10-12 years. We’re now on the WISC-V which came out in 2014.

What was wrong with the WISC-IV? Why did they have to change it? There are several reasons the WISC is updated. One is to reflect what we’ve learned about abilities. For example, the WISC-V places a greater emphasis on fluid intelligence which we’ve learned is a critical higher order process. It also separates fluid and visual-spatial reasoning into separate processes, as they should be. Tests are also updated in order to re-norm them. The “norm group” is the group of people in the test sample that constitute the comparison group. Newer versions of the WISC try to ensure that the norm group is representative of the current population, with representative samples from different ethnic groups, income levels, IQ levels, etc. Also, re-norming is important to compensate for the Flynn effect. I could write a whole blog about the Flynn Effect, but the gist of it is that IQ scores in the population are increasing, so if we use older IQ tests today we are likely to get inflated scores. This is one reason why scores on tests like the Stanford Binet-LM are suspect (in my opinion) as that test was published in 1972. There are newer versions of the Stanford Binet but some testers prefer to use the older version partly because it results in higher IQ scores.

But I’m supposed to be talking about the WISC-V. At first I was excited to see it conformed better to what we know about intelligence today. But then I began noticing that there are some problems, especially for 2e gifted identification. I reached out to some colleagues and it turned out a number of us were concerned. So we decided to figure out what was going on and try to do something about it.

Why is it harder to identify gifted and 2e students with the WISC-V? There were a number of changes from the WISC-IV to the WISC-V which have made it less useful in identifying gifted and 2e learners. One was to have the Full Scale IQ score calculated from only 7 tests rather than the prior 10 subtests. I can only imagine this was to make it shorter to administer. They also reduced the number of subtests in each of the key composites (Verbal Comprehension, Working Memory, etc.) from 3 subtests to just 2. They added a fifth index (visual spatial). Nice, but the use of five indexes skews the longtime balance between verbal and visual reasoning toward visual. Yet, children are often referred for testing for giftedness based on articulate verbal expression, and we need robust measures of verbal intelligence to identify them. Furthermore, substitutions are no longer allowed to accommodate disabilities; only one substitution is permitted within the Full Scale IQ score. In the past we could substitute certain tests emphasizing higher order reasoning processes which are better measures of giftedness. Discontinue criteria (the point at which the tester stops asking questions when the student has gotten several in a row wrong) on the WISC-V (compared to the WISC-IV) were shortened from four or five items missed in a row to three for most subtests. This again makes the test shorter to administer but may prevent a student from showing all they know. Use of timing on subtests has increased on the WISC-V. Two key subtests allows only 30 seconds for the most difficult items. Gifted students who are more contemplative in nature and not as speedy are really disadvantaged. Plus – and this is egregious in my opinion – they haven’t yet published an Extended Norms table for the WISC-V for calculating IQ’s of super-bright children. That deserves another separate blog post…

But let me get to the good news. We discussed the matter in the assessment committee of the National Association for Gifted Children (NAGC), and decided to take the issue on. In August 2018 we published this Position Paper with recommended guidelines for use of the WISC-V in the assessment of gifted and twice exceptional children.

All position statements are approved by the NAGC Board of Directors and are consistent with the organization’s position that education in a democracy must respect the uniqueness of all individuals.

The NAGC recommends that the WISC-V Full Scale IQ score not be required. In fact, it states: “The Full Scale score may…impede efforts to ensure that gifted classrooms, programs, and schools are accessible to children with disabilities.” This is a disability rights issue!

Instead, the NAGC recommends that any one of the following WISC-V scores (subtests in parentheses), should be accepted for use in the selection process for gifted programs:

• The Verbal (Expanded Crystallized) Index (VECI): (Similarities, Vocabulary, Information and Comprehension),
• The Nonverbal Index (NVI): (Block Design, Matrix Reasoning, Coding, Figure Weights, Visual Puzzles, and Picture Span),
• The Expanded Fluid Index (EFI): (Matrix Reasoning, Figure Weights, Picture Concepts, and Arithmetic),
• The General Ability Index (GAI): (Block Design, Similarities, Matrix Reasoning, Vocabulary, and Figure Weights),
• The Full Scale IQ Score (FSIQ): (Block Design, Similarities, Matrix Reasoning, Digit Span, Coding, Vocabulary, and Figure Weights), and/or
• The Expanded General Ability Index (EGAI): (Similarities, Vocabulary, Information, Comprehension, Block Design, Matrix Reasoning, Figure Weights and Arithmetic).

Note: The test developers (Pearson) have a technical report in progress with tables for calculating this last index. All the other indexes can be calculated by test scoring software or the use of tables in the test manual and technical reports.

Why is this important? Because now gifted children can be more readily identified for their strengths without their relative weaknesses pulling them down. This is especially critical for the twice-exceptional who have cognitive profiles full of extreme ups and downs. You don’t want to “average” that profile to the 50th percentile! In addition, if a child is gifted in one higher order reasoning area but not the other, their strength can still shine. I often work with children who are exceptional at fluid reasoning but not verbal comprehension. Or the reverse. They’re still gifted.

What should parents do? First, make sure whoever tests your child administers enough subtests to calculate the above indexes. If they just give the 7 subtests in the Full Scale IQ you won’t have what you need. You will need at least the following 13 subtests to be administered: Block Design, Similarities, Matrix Reasoning, Digit Span, Coding, Vocabulary, Figure Weights, Visual Puzzles, Picture Span, Information, Picture Concepts, Comprehension, and Arithmetic.

Second, lobby for your child using the Position Paper as support!

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.

There’s a big gap between how ADHD should be diagnosed and treated and what too often happens in the real world. Far better outcomes would occur if we avoided these pitfalls and did it right. Here’s what I see as the five mistakes that are often made:

1. Cursory evaluation. While it’s tempting to just examine whether the child has ADHD, often there are complicating factors arguing in favor of a comprehensive evaluation. The child might be inattentive because he or she is gifted, has dyslexia, is depressed, has a growth disorder, or a multitude of other factors. If these alternatives remain unexamined we may never know if the child actually does have ADHD, or whether another problem is the real cause of their symptoms. Even if the child does have ADHD a failure to identify commonly accompanying conditions leaves those challenges unaddressed. Comorbidity is the coexistence of physical or psychological challenges. ADHD and dyslexia are comorbid in 25 to 40% of cases, ADHD and depression in 20% to 30%, and ADHD and anxiety in more than 25% of cases. For autism, comorbidity rates with ADHD range from 37% to 85%. So I’m a big advocate of comprehensive evaluation.

Even when an evaluation focuses solely on whether the child has ADHD, it is often too limited in scope. I see this most often when a general pediatrician who has not received much training in ADHD bases a diagnosis entirely on two 10-minute forms: one filled out by a parent and one by a teacher. A lot of children are put on ADHD medications based on just this sort of brief evaluation. A proper ADHD evaluation should include at least: a thorough developmental history; parallel behavior rating scales filled out by multiple reporters at home, school, and self-report; neuropsychological tests of attention performed in an office; observations of parent-child interaction and child behavior; and – optimally – classroom observations.

2. Willing the results to go one way or another. Since a good chunk of the information contributing to an ADHD diagnosis comes from parent and teacher reports of behaviors they feel they observe, bias and perspective can come into play. Often I see teacher reports weighing strongly in favor of a diagnosis and parent reports suggesting there is no problem whatsoever. Or the opposite. Or a father who sees no symptoms and a mother who sees many. As beauty is in the eyes of the beholder, so is ADHD. A highly structured teacher who values control and compliance may be more likely to see a child’s behaviors as indicative of ADHD than a permissive, creative teacher who values spontaneity. Sometimes parents or teachers are eager for a “quick fix” in the form of a “magic pill.” Sometimes teens or young adults want an ADHD diagnosis to get their hands on a pill they feel may give them a leg up in the competition for good grades and college admissions. Sometimes parents are reluctant to have their child given a potentially stigmatizing diagnosis. A good evaluator needs to see beyond these motivations.

3. Pursuing treatments that have no (or very little) scientific evidence to support their effectiveness. I can’t begin to tell you how often well-meaning parents are drawn to alternative, untested therapies that have little or no scientific evidence of effectiveness. These include neurofeedback, CogMed, acupuncture, special diets, fish oil, and the like. I understand why parents do this. They are hoping for a solution that avoids medication. But the majority of these approaches are not evidence-based (there is no scientific evidence to suggest that they actually do any good). Most will do no harm, but a lot of time and money can be wasted. The “evidence” that does exist supporting many of these approaches is purely anecdotal and there may be a placebo effect at play. I don’t work for the pharmacology industry and I have no vested interest in reporting that the scientific evidence, over 75 years of research, indicates that stimulant medication is effective at improving concentration and reducing impulsivity and lack of control in 80% of individuals with ADHD.

4. Not taking the time to carefully trial type and dosage of medication. When a family decides to try medication, too often the prescribing doctor doesn’t take the time to carefully trial the different types of medication available and find the best dosage for that particular child. It’s not a “one size fits all” science, and there is no way to predict in advance which medication and what dosage will work best. Sometimes a 160 pound teenager needs less than a 6-year old. Sometimes an amphetamine like Adderall is better than a methylphenidate like Ritalin. Sometimes short-acting formulations are better than long-lasting. What should happen is a careful trial of several different dosage levels and different medications with feedback from parents, teachers, and the child on effectiveness. Far too many clinicians fail to take the time to do this. Even when an optimal medication is found, it’s important to continue with regular, ongoing evaluations of its effects and monitor changes over time.

5. Failing to also implement behavioral interventions. While medication certainly can help it can’t solve everything. A child with ADHD usually doesn’t have the same kinds of intrinsic motivation for task completion and performance as others. Regular, consistently delivered rewards (and punishments) may be needed in the classroom and at home to optimize performance. Clinically-administered behavioral therapy and/or social skills training may be needed. For older children cognitive behavioral therapy can have real benefits. Parent training can be very helpful for learning how best to manage the child’s behavior.

I urge my clients to take the time to do it right. Get a good evaluation, try to be impartial about the results, be scientific about the treatments you pursue, and realize that a pill can’t fix everything.

And in the midst of all this please don’t forget to focus on your child’s strengths (see my blog titled  Top 10 ADHD Superpowers).

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!

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.