Q: I am curious about your thoughts about differential diagnosis of 2e kids. It seems like many disorders have overlapping symptoms and many similar symptoms can have different root causes. When you throw giftedness into the mix, it just muddies the waters further. Are there assessments out there that help shed some light on whether a gifted kid has these issues or are there specific ways to interpret IQ and achievement data to know whether these may be issues for our kids?
A: Yes, indeed, there is much overlap. I agree that adding giftedness to the mix makes diagnosis that much more difficult. There are no easy answers when assessing 2e students, and assessments can help shed some light these issues. Using cognitive and achievement measures, depending on the issues or questions, can be very useful. In addition, the behavioral observations during testing prove quite useful in adding background to the data collected during formal testing. I am partial to the Wechsler Scales for cognitive, but there are many others that give good information, like the Stanford-Binet Intelligence Scales-Fifth Edition. The information from these individually administered tests gives you a great deal of information from both the performance side as well as the behavioral side. What is important to me in interpreting test data is how the tests scores relate to each other and the various differences you might see. For example, if a student does great on memory tests, but not as well on reasoning tests, it can signal that the youngster is using memory or relying on it instead of kicking in those thinking skills. That is a trap that some fall into because school is so easy they can remember everything without trying. By the way, that reliance on memory is something that could contribute to reading issues for some of our precocious readers. That is, they read before formal school (perhaps more from memory than phonics) so they do not bother learning phonics, resulting in problems later.
Q: I think I'm running into perhaps a philosophical discussion of what constitutes a "learning disability." I am thinking of a case where the child has, for example, an average reading achievement score, right about grade level, but her Verbal IQ Score is more than two standard deviations higher. Is this a reading disorder? Or does it depend on who you ask?
A: As far as what constitutes a learning disability (LD), I think in some cases it is in who you ask. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) identifies a learning disability when achievement is below expectancy for the age, ability, and educational level of a student. However, it seems to assume that chronological age, cognitive ability, and educational level are similar. For gifted children with significant asynchrony, there can be wide gaps between one’s ability and what might be expected for a child of that age. Many psychologists who work with gifted children agree that an LD is present when ability far outpaces achievement despite appropriate educational opportunities, even if the student’s achievement is average. Unfortunately, we do have problems convincing some schools of this because the child, in the eyes of a teacher, is “doing fine” or functioning at grade level. The National Association for Gifted Children has a Special Interest Group for assessment that is exploring this issue currently and hopes to be publishing about these identification issues soon. Another issue these days is Response to Intervention (RtI), as many schools are primarily using RtI to identify LD and other learning challenges. While RtI may provide some benefit in servicing gifted youth, it does not appear to be helping with the identification of 2e students in a regular classroom setting. Thus, it is becoming increasingly difficult to have gifted children identified with LD because, again, they are “doing fine” or progressing at grade level according to the teacher. For more on reading issues, you may be interested in The Dyslexic Advantage by Brock and Fernette Eide.
Q: How is the parent supposed to know that they must seek a professional evaluation and how often do parents need to seek re-assessment for their gifted child?
A: In many cases, if a parent is even considering evaluation, there is a reason for doing so and the results could be beneficial. Do the issues appear to be affecting a student’s learning, school performance, relationships, or self-esteem? How much are the concerns getting in the way? If yes and to a significant degree are your answers, then seek an evaluation from someone experienced in working with 2e kids. In cases like these, assessment can often shed light on the specific concerns and, more importantly, identify a path toward remediation or compensation.
Re-testing is interesting. Some believe that it should occur every three years, just like schools are mandated to do for special education students. I prefer to test when needed, rather than just because it is time. Achievement scores, like those from the Woodcock-Johnson Tests of Achievement-Third Edition, are good to have every one to three years to check progress, especially if parents are concerned that the child is not being challenged. These results allow parents and educators to clearly gauge how much progress is being made. In the case of a student with an LD, re-testing after intervention makes sense. However, re-testing with an ability measure like the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) may or may not be needed. In fact, if you have a really high WISC-IV score, unless there are some questions about its accuracy or a new score is needed for program qualification or other reason, I don’t see much need to re-test that…ever. We already know she is “smart enough” and has enough ability to succeed if she applies herself. As long as things are going well, parents are comfortable with the educational system adequately meeting needs, and the student is feeling reasonably challenged, cognitive or ability re-testing may not be necessary. The benefits gained from re-testing should always outweigh the costs, which can be significant.
Q: When families receive an assessment, the volume of information received may feel like one is being deluged with a fire hose. After an assessment is completed, challenges are identified, and a list of recommendations is compiled, how can parents prioritize the recommendations? Do you have any guidelines for knowing when a coach/tutor/therapist is a good match or when to "cut bait" and keep looking for a better fit?
A: As for prioritizing, I usually start with the problems that are getting in the way the most, while others prefer to start small and build on that. Either way, I see it as important to find and reinforce success. If you start with something big, identify the positive steps along the way. If you find yourself asking “What progress have we made?” try to address that with the coach/tutor/therapist and if you don’t get satisfactory responses, consider a change. The more specific the goals and sub-goals are, the easier it is to measure progress. The book Peak Performance for Smart Kids by Maureen Neihart talks about SMART goals (Specific, Measurable, Attainable, Realistic, and Timely). If these are set with regard to therapy, tutoring, or coaching, it is much easier to determine progress. If no progress is apparent, seek a change.
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