March 12, 2020
Gifted children represent a disproportionate amount of children identified with ADHD, which is as widely misdiagnosed as it is misunderstood and mistreated. The high rate of over-diagnosing this condition places gifted children at risk for being further misunderstood and mistreated as they fail to respond to traditional ADHD interventions. It is important to understand the components involved in an intact attention and executive function system in order to avoid misdiagnosing and over-pathologizing gifted children.
Asynchronous development is a commonly observed phenomenon of gifted intellect. However, the term is never associated with the brain function from which it originates. The presentation of asynchronous development predisposes many gifted children to be misdiagnosed with various psychiatric illnesses, including depression, Autism Spectrum Disorder, and Bipolar Disorder, just to name a few.
Typical gifted children, and those with a significant expression asynchronous development, often find themselves ostracized, misunderstood, bullied and questioning themselves. The small and large problems gifted children repeatedly experience can have lasting negative effects. Their normal way of being can result in a cumulative trauma expressed as anxiety, low frustration tolerance, and academic indifference.
It remains increasingly important for mental health providers and parents alike to understand the unique challenges faced by gifted children, so as to not overly pathologize them.
Paul Beljan, PsyD
Neuropsychologist
]]>March 17, 2020
Lecture Abstract
Characteristics of gifted and talented children can result in incorrect diagnoses, such as overlooking learning disabilities. Learning disabilities can take the form of academics (reading, math and writing) or innate abilities in general learning that may relate to social learning. In 2011 at Learning Pathways in Boulder, Colorado, Dr. Beljan gave a lecture on the basic tenets of gifted intelligence and asynchronous development.
Dr. Beljan discusses the in's and out's of giftedness and basic neurodevelopment. He then turns to the nuts and bolts of learning disabilities - what they look like, how to assess them, and what to do about them in the contexts of the gifted population. The ‘discrepancy model’ of learning disability is dispelled in favor of understanding the brain-basis of learning disabilities.
Check out the live lecture from 2011 at Learning Pathways in Boulder, Colorado
- Five or more symptoms of inattention and/or ≥5 symptoms of hyperactivity/impulsivity for ≥6 months to a degree that is inconsistent with the developmental level.
- Several symptoms were present before the age of 12.
- Several symptoms must be present in two or more settings (i.e., at home, school, or work; with friends or relatives; in other activities).
- Symptoms interfere with or reduce the quality of social, academic, or occupational functioning
- Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication, or withdrawal).
If we have established criteria, then why do school teams have such difficulty specifying how a particular student is impacted and what interventions, remediation, and/or supports are needed?
ADHD isn’t homogeneous. It looks different for everyone, both in terms of brain function and impairment. Related to brain development, prior to age 12, children are more likely to present as hyperactive. At age 13, children are more likely to present as inattentive or combined type. Symptoms may fluctuate daily, making diagnosis and impact statements difficult to summarize. Symptoms may overlap with an array of other mental and physical health concerns, such as anxiety, depression, sleep disorders, brain injury, or thyroid functioning.
How does this affect my student’s learning?
- Attentional capacity: the amount of information that can be held temporarily in memory
- Working memory: hold AND to manipulate information in some way (auditory and/or visual)
- Sustained attention: remain focused for a prolonged period of time
- Selective attention: stay focused in the presence of distractors
- Response inhibition: stop oneself from doing something
- Cognitive flexibility: shift and to refocus on another stimulus or task
- Processing speed: the time it takes to complete simple tasks
How does this affect my student’s emotional regulation, social communication, and friendships?
- Impatience/impulsivity with friends and peers
- “Overreacting” or “underreacting” in response to strong emotions
- Needs more time to regulate and to return to normal after heightened feelings
In the high school classroom, the combination of inattention and difficulty with inhibition control looks like…
- Difficulty listening to lectures
- Difficulty starting/finishing an assigned task
- Difficulty remaining in seat
- Difficulty working collaboratively with peers
- Difficulty completing chores
- Difficulty completing self-care tasks
- Difficulty making and keeping friends
- Prospective memory (i.e., "when I get home, I need to...")
- Issues with time
Common Accommodations
- Preferential seating: One of the most commonly written classroom accommodations. However, on its own, it’s not a particularly useful strategy. It can be helpful when it’s part of a broader combination of accommodations
- Testing in a separate location: This is dependent upon a student’s distractibility. Some need the direct support of an adult to sustain attention or to return to task.
- Noise canceling headphones: Can be very helpful in reducing environmental noise
- Extended testing time: The most common accommodation in IEPs and 504s. Research is mixed. Executive functioning deficits mean students with ADHD don’t make good use of time. However, if a student with ADHD also has reading comprehension difficulties, they are more likely to benefit from additional time
Interventions vs Accommodations
Both are helpful, but interventions generally lead to better long-term outcomes. Common examples in teaching notetaking vs providing a copy of teacher notes and organizational training vs helping organize a binder. Consider social skills training combined with real-world reminders and feedback in real time. Cognitive/behavioral training helps to build organization, planning, compensatory strategies to manage distractibility, building flexible thinking and problem solving. Parents may need support to help establish rules, set expectations, create home routine, and to better implement positive reinforcement. Outside of the school setting, some studies suggest that daily cardio exercise helps attention and memory. Also important is sleep hygiene to improve bedtime resistance, falling asleep, staying asleep, waking up on time, and to reduce feeling sleepy during the day. Better sleep = better emotional/behavioral regulation and better working memory.
]]>It is recommended that your request be sent via email, which provides an automatic date and time stamp. Given the challenges in school staffing and outdated websites, I’d recommend sending your emailed request to a few different individuals to ensure that the request is received and forwarded to the designated person. This includes the school psychologist, school counselor, principal, and/or special education director.
Many families use form letters/emails found online or ask their medical provider to write a prescription (script) for an evaluation or IEP. These templates often are outdated or refer to regulations and timelines from other states. I’d recommend that you not use these form letters. In addition, the school is not obligated to follow the doctor’s orders. The most effective requests I received when working in the schools included a brief history of the concern(s) and the current impact. It was easy for me to understand the nature of the concern(s), to follow-up with the family, and to loop in other relevant school personnel, such as the speech and language pathologist or occupational therapist. The email does not need to be lengthy or overly detailed. You do not need to “argue your case.”
Then what?
From Arizona Department of Education: If a parent requests an evaluation, the school must, "within a reasonable amount of time not to exceed 15 school days from the date it receives a parent's written request for an evaluation, either begin the evaluation by reviewing existing data, or provide prior written notice refusing to conduct the requested evaluation. The 60-day evaluation period shall commence upon the [school's] receipt of the parent's informed written consent" "and shall conclude with the date of the Multidisciplinary Evaluation Team (MET) determination of eligibility."
What does this mean?
- The school receives your request for evaluation. While the request can be made verbally or in writing, written requests are recommended for easier records keeping.
- Within 15 school days, the school either must begin the evaluation by convening the team to review existing data or providing written notice of its refusal to evaluate.
- The school will reach out to schedule a meeting to review existing data. After agreeing to the date and time, you will be provided with written notice of that information, the purpose(s) of that meeting, and the anticipated participants.
- At the meeting to review existing data, the evaluation team will determine if additional information is needed before considering eligibility under one or more of the 13 IDEA categories of eligibility.
- If additional data are needed, the evaluation team will document that and provide the parent with an assessment plan that states what areas will be assessed (general cognition, memory, anxiety, reading, fine motor, communication, etc).
- Once the parent/guardian has signed the assessment plan, the school/district has 60 calendar days to collect the data and to reconvene to review the new information and to make a determination of eligibility.
Kate Haskew, CAGS, NCSP, ABSNP
Director of Academic Services
Kate is an Arizona and nationally certificated school psychologist and earned the status of Diplomate in School Neuropsychology from the American Board of School Neuropsychology. Kate’s background enables her to integrate neuropsychological principles and educational practices to assist students and their families in understanding unique learning needs and facilitating progress within the school system. In addition to being a member of the Beljan assessment team, Kate specializes in wraparound services that link evaluation data with the practical implications for academic and personal development.
We are excited to now provide an expanded number of services for Autism Spectrum Disorder. Our providers offer traditional ADOS testing in addition to a novel integrated approach to Autism assessment utilizing principles from pediatric neuropsychology and speech/language pathology to give you a more comprehensive understanding of how Autism may be affecting more than just your social interactions.
Approved use of ESA funds includes a wide variety of educational expensing, including reading, tutoring, and neuropsychological evaluations.