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As many of our children head back to school they will be handed short self-report questionnaires to determine their “learning style.” A recent study found that over 90% of teachers still believe that children learn better if they receive information in their preferred learning style. Despite the evidence.

It’s a well-meaning notion – most teachers sincerely want to reach all of the children in their classes. And children generally find it fun to be given an opportunity to tell their teachers how they prefer to learn (of course many children would probably say they learn best by video gaming, but that isn’t likely to be among the options on the questionnaire!)

What are “Learning Styles?” There are more than 70 different theories or models of learning styles including: “left vs right brain,” “concrete vs abstract,” holistic vs serialist,” and so on. But by far the most popular model sorts children into three “types:” visual, auditory, and kinesthetic. The visual learner is said to learn best by seeing graphs, charts, videos, and other visual displays. The auditory learner is said to learn best though aural or heard information – by listening. The kinesthetic learner needs movement and hands-on tasks to maximize their learning.

The way students are identified as being one “type” or another is by filling out a self-report questionnaire with items such as: “I like to learn with posters, videos and pictures” and “If I have to solve a problem, it helps me to move while I think.”

Where did the notion originate? The idea likely grew in popularity from the combined effects of the self-esteem movement (all children are special and deserve respect of their differences), the need for teachers to teach a wide variety of children utilizing differentiation in mixed classrooms, and findings in neuroscience that different areas of the cortex have specific roles in visual, auditory, and sensory processing. I believe it caught on because it’s one of those ideas that sounds scientific and intuitively reasonable.

Is there any scientific evidence to support of the notion of learning styles? The answer is no.

And it’s not simply a matter of “the absence of evidence doesn’t mean the evidence of absence.” On the contrary, for years researchers have tried to make a connection through hundreds of studies. In 2009, Psychological Science in the Public Interest commissioned cognitive psychologists to evaluate the research on learning styles to determine whether there is credible evidence to support using learning styles in instruction. They came to a clear conclusion: “Although the literature on learning styles is enormous,” they “found virtually no evidence” supporting the idea that “instruction is best provided in a format that matches the preference of the learner.” Many studies suffered from weak research design, rendering them unconvincing. Others which did have effective experimental designs “found results that flatly contradict the popular” assumptions about learning styles. In sum, “The contrast between the enormous popularity of the learning-styles approach within education and the lack of credible evidence for its utility is, in our opinion, striking and disturbing.”

Students who implement study strategies based on their self-reported learning style do no better than students who don’t.

In addition, evidence shows that learning style questionnaires are unreliable because people’s self-reported preferences are poorly correlated with their actual performance. In other words, a person might think they learn better, say, visually rather than verbally, but their performance may say otherwise. And of course learning will depend on the nature of the material we’re being taught. Can you imagine trying to learn French grammar pictorially or learning geometry purely verbally?

Learning will also depend on the distinct cognitive abilities profile of the learner – something far more complex than any simple notion of a “learning style.” A student with dyslexia may well learn better by listening than reading. A student with an auditory processing disorder may learn better by reading. A student with ADHD may benefit from opportunities to get up and move around.

What should parents do? If your child brings home results from a learning styles questionnaire, explain to them that what it means is that their teacher wants them to learn and that they should help their teacher out by letting them know when they don’t understand a concept being taught.

What is Central Auditory Processing Disorder?

Central Auditory Processing Disorder (CAPD) – also known as Auditory Processing Disorder (APD) – is an umbrella term for a variety of disorders that result in a breakdown in the hearing process. It is not due to peripheral hearing loss, but rather has to do with the way the brain processes sounds. It’s what the brain does with what the ears hear. The American Speech Language Hearing Association (ASHA) defines CAPD as a deficit in one or more of a number of skills, including difficulties knowing where a sound is coming from (sound localization); the ability to detect changes in the duration of, and time intervals between sounds (temporal processing); and the ability to detect spectral variations in sounds (particularly those that differentiate sounds between phonemes). CAPD affects between two and 20% of children.

The debate

A debate flares up about auditory processing disorders frequently between disciplines.

One side of the argument – often coming from psychologists –  is that CAPD is not a valid and reliable “diagnosis,” that the tests assessing auditory processing have poor psychometric properties (lack reliability and validity), and that information gained from an auditory processing evaluation doesn’t help us develop treatment plans in any event. This side often points out that there’s a lot of overlap between CAPD and ADHD, CAPD and developmental language disorders (e.g. speech and language), and CAPD and dyslexia, and that it’s very hard to distinguish among these conditions and between their symptoms. Psychologists may point out that the clinicians testing for CAPD are audiologists who have little to no training outside their specialty, which may be one reason they tend to think everything is an auditory problem.

The other side of the argument – often coming from audiologists – acknowledges that while there are overlaps and comorbidities between CAPD and other disorders, it nevertheless exists as a separate entity. They argue that there are measurable, replicable decrements in central auditory processing that cannot be otherwise accounted for by overlapping diagnoses such as ADHD or language disorders. Some children who are perfectly able to pay attention in quiet environments cannot do so in situations with high levels of background noise like the typical elementary school classroom. An audiologist may argue that this is because they have difficulty processing speech sounds embedded in ambient noise – not because they have an attention deficit. However, over time they may begin to look as though they have ADHD if the effort of trying to listen grows so tiresome that they “give up” and “tune out.” And they may begin to have speech and language and reading difficulties as auditory processing underlies both phonemic processing (which underlies reading) and linguistic processing (which underlies speech and language).

Who’s right? Is it a real diagnostic entity?

I think it is “real.” It’s now listed in the American Medical Association’s International Classification of Diseases, Tenth Revision (ICD-10) code as a distinct medical condition separate from mixed expressive-receptive language disorders, where it used to be lumped.

But I agree it’s really hard to distinguish it from other disorders. The primary professional organization for diagnosticians of CAPD, ASHA, states on their website description of CAPD that “there is no universally accepted method for screening for CAPD,” “there is currently no reference standard for diagnosing CAPD,” and that even among clinicians who do diagnose it that “diverse perspectives among interdisciplinary team members involved in the evaluation process may result in different diagnoses.” If you take your child to an audiologist you may get a diagnosis of CAPD, but if you take your child to a Speech-Language Pathologist (SLP) you may get a diagnosis of a language disorder. A psychologist may provide a different diagnosis altogether.

I can tell you from my personal experience that audiologists and speech-language pathologists and psychologists speak entirely different languages and do not often know much if anything about each other’s areas of specialty. I took my son to a speech-language pathologist who diagnosed a language disability. I took him to an audiologist who diagnosed CAPD. And I took him to a psychologist who diagnosed ADHD and dyslexia. It reminded me of the parable of the blind men and the elephant.Does it help to get a diagnosis?

I’m not so sure. It can help to know why your child behaves in certain ways. Parents who are aware their child has an auditory deficit may be more sympathetic when they appear to not be listening to oral instructions (how many times did I have to tell my son to brush his teeth…?) and consider school options with lower levels of noise (e.g. small classes, no open classrooms, homeschooling). And it can help to know there is CAPD if it really seems there is nothing else going on. But usually there is something else. And I honestly feel there isn’t a whole lot to be gained from the additional knowledge that CAPD is in the mix.

Interventions for auditory processing disorders fall into two categories: therapy and accommodation. Dr. Theresa Bailey, a pediatric neuropsychologist who has written extensively about this topic, feels that neither has sufficient documentation to meet an evidence-based standard of care. Therapies like Fast ForWord and auditory integration therapies like Berard AIT should be considered experimental at best, despite widespread clinical availability. Accommodations include the use of a sound-field FM amplification system in which the child wears a special headset and the teacher wears a headset with a microphone and transmitter. How many kids (or teachers) want to do that? And they may not help much anyway. The research on benefits shows contradictory findings. We just don’t know what kinds of interventions or accommodations provide measurable benefit to a child with auditory processing deficits. There may be treatments that are effective for CAPD developed in the future, but they aren’t available yet.

But we do know what kinds of interventions and accommodations help with speech and language, reading, and attention deficits. Since estimates are that 84% of children with CAPD have ADHD and as much as 100% of children with CAPD have impaired language abilities, our attention might be better focused in these areas.

What should parents do? If you decide you want to assess your child for auditory processing deficits, have a multidisciplinary team involved. The measurement of central auditory functions should be conducted as just one component of a comprehensive evaluation in order to understand the totality of what is contributing to the child’s learning challenges. And try to have a professional involved who is knowledgeable about the multiple disciplines who can help you figure out what it all means.

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.

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

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

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

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

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

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

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

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

I feel badly he had to ask.

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

Books:

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

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

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

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

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

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

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

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

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

Websites, Facebook, and Other Resources:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I was asked to write an article on this topic for TECA (Twice Exceptional Children’s Advocacy), an online community providing service and program directories and information about advocacy. I decided to enlist the help of Benjamin Meyer, a therapist specializing in young adults with NVLD and Asperger’s in the workforce. Here’s what we wrote:

By Benjamin Meyer, LCSW and Dr. Devon MacEachron, PhD

You did it! Your child has finally received an acceptance letter to a college or university and is beginning his or her first steps toward adult life. All your hard work navigating the treacherous path of diagnosis, remediation, social skills training, OT, PT, gifted programming, IEP’s and 504’s has paid off. You deserve a lot of credit for all that you have done to guide your child through the process, and you certainly deserve to celebrate!

While high school has come to an end, it is important to keep in mind that even after college, your child may face challenges related to their disabilities. These can include identifying and finding a career they enjoy, adapting to the world of employment, making friends with peers, and adult dating. Many young adults with learning differences are unemployed or underemployed due to the more nuanced social and executive functioning demands of the workplace, The National Center for Learning Disabilities reports that only 46 percent of work-age adults with an LD are employed (Cortiella, 2014) . “Failure to launch” has become a national epidemic, with many young people returning home to live with their parents due to challenges with the professional and social demands of adulthood. Your high school grad will be at an advantage if they take a few practical steps while in college to prepare for the “real world”.

Young adults in our practices often identify specific challenges at work related to their learning profiles. The dyslexic who chose engineering or architecture due to his gifted visual-spatial skills may find that slow speed and miscalculations made in math problems hinders his ability to complete tasks efficiently. The ingenious marketing professional with ADHD may experience difficulty organizing her ideas into action plans. The gifted writer with Asperger’s Syndrome or NVLD may struggle to hold regular employment due to difficulties reading their peers’ body language. Young adults who plan in advance for a career or job that will be a good fit for their unique profiles are most likely to be successful transitioning to the world of work.

Finding the Sweet Spot

When deciding on a career, young adults can search for the “sweet spot” where their strengths, interests, and values coincide (see diagram). The blue circle represents strengths. These should include intellectual talents as well as people skills, executive function, willingness to work hard, artistic, musical, and any other abilities. The green circle encompasses interests: sports, outdoor activities, academic subjects – any and all interests the individual may have. Lastly, it is important to identify and “own” the personal values that can impact career satisfaction. These include: how important a flexible work schedule is, how much social interaction is desired at work, the hours one is willing to work, desire for autonomy and independence versus taking direction from a boss, whether one enjoys working on a team, being outdoors versus in an office building, how important a high salary is, how important it is have a high prestige position, whether one wants to be considered an expert or authority, how important it is to feel one is helping others or making the world a better place. Values go in the yellow circle. By identifying the key factors that influence career success and happiness, young adults can begin to see which careers might fall within their “sweet spot.”

Acknowledging and Factoring in Areas of Challenge

While students are searching for their “sweet spot,” they will also benefit from being honest with themselves about their challenges. There are certain skills that are important in practically any job. Relating to colleagues, keeping your emotions in check, taking initiative, and having an organizational system are a few of them. There are also specific skills required in different fields, e.g. math skills for an actuary or writing skills for a journalist. If the student feels they have a weakness in an area important to a career they feel they would like to pursue, they can work on developing those skills while still in college. For example, they might learn to create an organizational system with a coach or work with a therapist on professional social skills. The student will also benefit from consulting with professionals who are in the field they are considering, especially those who have a similar profile of strengths and weaknesses. This will help them assess how suited their specific strengths and weaknesses are with the demands of the job and will aid in identifying some strategies for compensating for their weaknesses. Internships and mentorships are ideal opportunities to practice compensation strategies while building on strengths, experience and expertise.

Case Studies

Jacob is a verbally gifted 2e student with nonverbal learning disability interested in becoming a social worker. He realizes that he may find meeting documentation requirements challenging due to executive functioning deficits, while also facing obstacles reading nuances in body language from colleagues and employers. On the other hand, his strengths in writing and verbal skills will help him to produce well-written progress notes and describe cases in detail. As is the case for any 2e student, expressing specific strengths to potential employers during and after the interview process is a critical skill for landing a good job. Twice-exceptional students have exceptional strengths and these can be a major attraction to employers. But prospective employers may not know what those are until the applicant articulates them in a clear and concise way, convincing the employer of their value. Jacob needs to sell his verbal and writing skills. At the same time, he should anticipate concerns about weaknesses and consider addressing them up front. If a prospective employer knows that Jacob has NVLD and what NVLD means, they might be concerned about Jacob’s organizational abilities. Jacob would be wise to highlight in the interview process that he worked on developing a unique filing system at his last job, and explain how this skill will help him be an effective social worker.

Neil is a brilliant mathematician and visual-spatial thinker with Asperger’s and ADHD. He struggled with attention and making friends in college, however he successfully identified a strong interest and talent in architecture. Neil knows that he will no longer have access to a note taker, extra-time on tests, and academic coaches to help him stay on task in the work world. Also, an understanding of business social skills will be critical for him to engage effectively with clients in this field. During his last two years of college, Neil decided to work with a therapist building business-savvy social skills. During the summer when he is interning at an architecture firm he intends to consult with a business organizational coach and mentor who understands some of the demands he is likely to face in an architecture career. When Neil interviews for full-time jobs after college he may request “reasonable accommodations” that will not create an excessive burden for the employer. These could include extra filing space, access to a computerized organizational system, and a co-worker to accompany Neil to organizational meetings and provide professional feedback, etc.

Caroline is a 2e student who is dyslexic and has ADHD. She wants to be a journalist. She hit some road-bumps along the way in college from her ADHD and as a result it took her 6 years to graduate. She’s decided she needs to address this up-front in her interviews by explaining that she has ADHD, what happened, and what she learned from it (e.g. how to be organized, how much she cares about learning). When she mentions her ADHD she intends to emphasize that she thinks it is part of the reason she is so creative as a journalist and point to examples of creative stories she has published. But she doesn’t think her dyslexia will negatively impact her future work because she knows to get her pieces edited for spelling and grammatical errors. So she’s not planning on mentioning that exceptionality.

Does Your 2e Learner Have to “Tell All?”

It depends. In an ideal, open-minded, accepting-of-neurodiversity world one would be up-front about such things. No one wants to end up in a position that’s a bad fit. On the other hand, although they legally cannot discriminate, prospective employers may be concerned about hiring someone who brings challenges along with them. Many people don’t know about twice-exceptionality and may not get that one can be gifted and have a disability. We recommend the student decide in advance how much information would be in their best interests to divulge. The decision of what to share may be influenced by how overt the student’s weaknesses are. If you can’t hide it, own it. The decision may be influenced by the culture in the specific career field or company. Technology firms and academia tend to be more open-minded to differently-wired people. Traditional businesses like manufacturing and law may be less so. Of course if the student does decide to share, thought should be given to how to frame such information in the most informative light.

When a 2e student is proactive in preparing for future employment during the college years, their chances of success are greatly improved. These steps can include: researching and selecting a career that fits well with their unique profile of strengths, challenges, and values; working to address organizational and “soft skills” deficits while still in college; and finally deciding what and how much to self-disclose. Although 2e young adults may face challenges adapting to the workforce, they can be proactive about creating strategies for overcoming these boundaries, especially if they start doing so during the college years.

Benjamin Meyer, LCSW is a bilingual psychotherapist who provides psychotherapy and coaching services to young adults with High-Functioning Autism and Nonverbal Learning Disorder post-college in New York City. Dr. Devon MacEachron, PhD is a psychologist with expertise in twice-exceptional learners who provides psychological assessment and educational planning services to children, young adults, and their families in New York City.

Works Cited

Cortiella, C. &. (2014). The State of Learning Disabilities: Facts Trends and Emerging Issues . New York, NY : The National Center for Learning Disabilities.

Are you familiar with the 5 stages of grief?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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!