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My younger son did some quick screeners with a psychiatrist for stealth dyslexia, math issues, processing, etc.  She said she thinks he is just very smart and extremely bored with school.  He does have ADHD-inattentive, which we have been addressing with medication.  

Is it useful to run the IQ test to look at areas like working memory? I do think we have an issue but clearly we haven't pinned it down yet. It might just be that he checks out because he is so bored. 

 

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No you don't need IQ testing to check working memory. You can do digit spans, n-backs, etc. yourself. Do it with visual, auditory, even asking him to follow a sequence of commands. His working memory will become obvious very quickly. 

What's going on with him? You're not mentioning auditory processing. That and spectrum can be reasons people fade out. I definitely don't think I'd accept blame shifting. If she can't explain what you're seeing, someone else can. Any indication of seizures? Sensory differences? Odd things you can't put your finger on?

Is it that you want an explanation or is it that you need something to change? You need information to make some kind of change or to better target intervention? 

An IQ test isn't going to do any of that for you. It's more of a question of what you're seeing and what would help you accomplish your goals. Oh you want to see if the IQ is high and that's an explanation? Well what's your insurance coverage? Why not go ahead and get a psych eval? If you're thinking gifted, look for someone on the Hoagie's Gifted list. 

Fwiw, the first neuropsych we used with ds did the blameshifting stuff, said it was all cuz he was so gifted (which he is btw), and now he has a nice fat ASD2 label. Stuff that in your pipe neuropsych.

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So, he is 13 (14 next week) and I know brain fog can be part of things at 13, but there were a few things more long lasting than that and I wanted to see.

He has ADHD-inattentive so I was also not sure if we were dealing with a need for a medication change. 

I notice that he is often picking at his fingers, not focusing on his work, *especially* when reading and doing math. It's like the math book triggers the need to pick.  LOL. He is on month 12 of Algebra I, which is fine, but from my perspective I am not seeing that the math is "easy" for him or that he gets it right away and he zooms through it. He's pokey and he sometimes makes conceptual errors.  So it's not all that he is speeding through it to get it done either. 

For writing, he is extremely hesitant, hates it, thinks he is bad at it, and I have to sit with him and help him for most every writing assignment. Again, not a "this is easy, let me crank this out" type of situation.

For any kind of memorization, it just doesn't stick as well as it could.  He doesn't retain things as long as my other child (for example, Spanish vocabulary), despite very regular review. 

For reading, he doesn't retain the stories like I would expect. We were talking about a book the other day, and my oldest mentioned it reminded him of a scene from The Magician's Nephew. My oldest read it three years ago. I read it six years ago. My youngest read it last fall.  My youngest didn't remember the scene at all. Did he zone out during "reading"? Did he not understand what he was reading? I don't know. That is why I went to the psych. It seems like she is saying that it is not any kind of dyslexia or processing thing, but I need to talk to her still (we just talked for a minute or two with my son present and planned to talk more on Friday).

I am not sure if she covered auditory processing--I will ask. I know she was doing screeners for processing and dyslexia, math, reading, etc.  I don't want to assume.

 

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The psych I sent you happens to have the TNL, so she can run narrative language testing. You're asking questions that cannot be answered without evals. The p-doc gave you the blow-off, which only means she doesn't own the tests to identify what's going on.

23 minutes ago, cintinative said:

I notice that he is often picking at his fingers, not focusing on his work, *especially* when reading and doing math.

Anxiety?

So I'm going to make a suggestion, because you want something you can do NOW that will make a difference NOW.

https://www.kelly-mahler.com/what-is-interoception/  

You should definitely do a psych eval, possibly with the name I sent you. If you use a different psych and they don't own the TNL or other language screeners, you'd be looking for an SLP who owns them. Again, I have a name for you, but it's just a hassle when you can get it under one roof. But hey, the SLP would own the TNL and the TAPS (test of auditory processing skills), so it could be a good way. 

So assuming you pursue evals and that they take 1-6 months at least to get in and get some feedback, in the meantime I'm suggesting you look into Interoception. Consider running through the curriculum with him, because it could up his self awareness, self monitoring, and self advocacy. 

You can read about things like https://www.efpractice.com  But all this is predicated on self awareness. So if he's at the point where he's picking and having anxiety and he is going to a pdoc and the pdoc isn't hearing this, then to me there's a self awareness and self advocacy gap. So I'm suggesting that you work on that to see what that opens up. It can't hurt and may make everything else go a bit better.

And, fwiw, you can get through phase 1 of the curriculum and get noticeable changes in 8 weeks. In other words, it's something that might help you make progress while you're waiting for evals.

In the meantime, also assume low processing speed and assume he needs active reading supports.

And yes, if his meds are not adjusted right and his dopamine is still low, it will affect that chemical process that takes info/learning from short term to long term memory. But anxiety and the attention are going to toggle here, which is where the self advocacy piece comes in. the more you get that, the more he can talk to his doc and get the help he needs.

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On 6/16/2021 at 3:00 PM, cintinative said:

My younger son did some quick screeners with a psychiatrist for stealth dyslexia, math issues, processing, etc.  She said she thinks he is just very smart and extremely bored with school.  He does have ADHD-inattentive, which we have been addressing with medication.  

Is it useful to run the IQ test to look at areas like working memory? I do think we have an issue but clearly we haven't pinned it down yet. It might just be that he checks out because he is so bored. 

Do you know where she got this idea, that he's just bored? 

I know that my highly accelerated DD8 does do really counterproductive and stupid stuff when bored. She'll make stupid mistakes. She won't gather terms in her algebra. She won't just race through things, because she simply can't force herself to work this well on something that's not engaging. She won't give the IMPRESSION of a kid who's bored, but she is. So I've definitely seen that before. 

But that's obviously not the only possible answer, so I'm curious where the impression came from. 

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12 minutes ago, Not_a_Number said:

Do you know where she got this idea, that he's just bored? 

I know that my highly accelerated DD8 does do really counterproductive and stupid stuff when bored. She'll make stupid mistakes. She won't gather terms in her algebra. She won't just race through things, because she simply can't force herself to work this well on something that's not engaging. She won't give the IMPRESSION of a kid who's bored, but she is. So I've definitely seen that before. 

But that's obviously not the only possible answer, so I'm curious where the impression came from. 

The more I talk with her the more confused I am. I didn't get to update this post, but she is now saying she thinks he has a little dyscalculia and a littls dyslexia.  Although neither are (probably) significant enough to get accommodations. She thinks that his dyscalculia shows up in mental math and quick math based on her screener (which she said is sort of like Xtra math).

When he was young he struggled to learn math facts. We tried XtraMath, BigBrainz, Reflex Math, skip counting songs, flash cards, worksheets, etc. Finally I thought he had it down. She is saying that is a sign that he had/has dyscalculia.  That said, we did Math in Focus (Singapore) from grade 1 on and there is quite a bit of mental math in it. I didn't notice a real problem until we started Algebra I in May 2020 (we're still working through it).  I do think he tries to do too much in his head. I am not able to skip so many steps in my head like he tries to do sometimes.  I always encourage him to write it all down. You know how it goes.  

So to be honest I am not sure. I sort of see the dyscalculia in the early issues, but I honestly think some of his issues now are more working memory issues than anything (and trying to do too much math in his head).  

On the boredom front, I could not tell you. I know he focuses more when he's interested? But isn't that true of most everyone? I do know that boredom can be an issue with gifted kids--they need to be challenged.  But with his ADHD-inattentive it would probably be hard for me personally to note when the distraction is due to that inattentive element versus boredom. My best guess is that sometimes one is the engine and the other is the caboose and sometimes that reverses. 

Edited by cintinative
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24 minutes ago, cintinative said:

The more I talk with her the more confused I am. I didn't get to update this post, but she is now saying she thinks he has a little dyscalculia and a littls dyslexia.  Although neither are (probably) significant enough to get accommodations. She thinks that his dyscalculia shows up in mental math and quick math based on her screener (which she said is sort of like Xtra math).

When he was young he struggled to learn math facts. We tried XtraMath, BigBrainz, Reflex Math, skip counting songs, flash cards, worksheets, etc. Finally I thought he had it down. She is saying that is a sign that he had/has dyscalculia.  That said, we did Math in Focus (Singapore) from grade 1 on and there is quite a bit of mental math in it. I didn't notice a real problem until we started Algebra I in May 2020 (we're still working through it).  I do think he tries to do too much in his head. I am not able to skip so many steps in my head like he tries to do sometimes.  I always encourage him to write it all down. You know how it goes.  

So to be honest I am not sure. I sort of see the dyscalculia in the early issues, but I honestly think some of his issues now are more working memory issues than anything (and trying to do too much math in his head).  

On the boredom front, I could not tell you. I know he focuses more when he's interested? But isn't that true of most everyone? I do know that boredom can be an issue with gifted kids--they need to be challenged.  But with his ADHD-inattentive it would probably be hard for me personally to note when the distraction is due to that inattentive element versus boredom. My best guess is that sometimes one is the engine and the other is the caboose and sometimes that reverses. 

Huh. This sounds confusing and unhelpful 😕 .

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Just now, PeterPan said:

Then maybe focus on what will make a difference. 

I think what I need to do is address working memory.  So I need to do some digging on that. I do have Smart but Scattered (the original, and the teens version) that I can look at. Any other suggestions?

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I have a kid with a very high IQ whose working memory is well below the first percentile.  It's a real issue and there was no mistaking it from early on.  There are things you can do to improve it, but the reality for us is, to get any improvement, we had to spend HOURS a day in activities that were extremely painful and awful for all of us.  And as soon as we stopped or slacked off even a little, all the improvement vanished into the ether.  So, with 3-4 hours a day of torture, we could get from 0.5th percentile to maybe 5th percentile, which makes a huge difference, but the cost was so high.  It totally burned out our ability to work together and was the end of homeschooling for us.  And despite huge efforts to keep sessions short, make it fun, she developed actual PTSD.  I'm not saying it's equivalent to war zones, but she became hypervigilant, weepy, had flashbacks to metronomes, had nightmares.  It tanked her self image.  She became far, far less willing to take any risks at all.  And if we took a week off, we were back down to 0.5th percentile again.  Frankly, the data says that our experience is not unusual.  There are a few treatments for working memory like Cogmed, but mostly the advantages are lost as soon as you stop doing the therapy.  

We shifted to trying to find accommodations for the low working memory.  She uses alarms for everything.  She writes everything down.  We accepted that there are things she probably won't be able to do.  She's much happier and more functional than I ever expected her to be.  

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26 minutes ago, Terabith said:

 

We shifted to trying to find accommodations for the low working memory.  She uses alarms for everything.  She writes everything down.  We accepted that there are things she probably won't be able to do.  She's much happier and more functional than I ever expected her to be.  

Thanks for sharing your experience. I was doing a little Googling today and there were a couple sites that said something exactly along the lines of what you lived out--that there are things/interventions you can do, but the results don't last long, and they are taxing on the child. One site said that you can't work on working memory in one area and have that overflow in all the others. In other words you work on it for math, and you also work on it for reading. 

For now what we are doing is using a calculator more often, and I plan to use audio books to hopefully help him focus while reading.  

Other than that, I had thought about using alarms as a way of a self-check (am I focusing? do I remember what I just read?).  How do you use alarms?

 

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4 minutes ago, cintinative said:

Thanks for sharing your experience. I was doing a little Googling today and there were a couple sites that said something exactly along the lines of what you lived out--that there are things/interventions you can do, but the results don't last long, and they are taxing on the child. One site said that you can't work on working memory in one area and have that overflow in all the others. In other words you work on it for math, and you also work on it for reading. 

For now what we are doing is using a calculator more often, and I plan to use audio books to hopefully help him focus while reading.  

Other than that, I had thought about using alarms as a way of a self-check (am I focusing? do I remember what I just read?).  How do you use alarms?

 

Mostly we use alarms to keep track of things that need to be done:  taking meds, brushing teeth, showering, work that needs to be done.  Stuff like that.

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Trouble with memorizing math facts often goes hand in hand with dyslexia, so that does not surprise me. DD16's school IEP allows her usage of a calculator; the idea is that understanding the concepts and how to do the problems is primary, and the calculator makes up for not being proficient with the memory. DD actually does okay, mostly, with remembering the steps to math problems, but when she had her neuropsych evaluation back when she was 10, the NP suggested as an accommodation having the steps to math problems on a reminder card that she could reference, as an accommodation for the working memory issues.

DD's tendency to rush is harder to accommodate 🙄. I think that is related to the impulse components of ADHD, and now that she's medicated (took a long time to get her a diagnosis, because teachers didn't see it), we're hoping the rushing will get better. You could talk to the doctor to see if a medication adjustment might help, in your son's situation. Sometimes one med, or an increase in the dosage, will work enough differently to improve functioning significantly. There are also some medications that can be added on (Strattera, for example, can be used along with other ADHD meds -- not promoting this; we don't even use it; it's just an example).

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6 hours ago, cintinative said:

The more I talk with her the more confused I am. I didn't get to update this post, but she is now saying she thinks he has a little dyscalculia and a littls dyslexia.  Although neither are (probably) significant enough to get accommodations. 

I do think he tries to do too much in his head. I am not able to skip so many steps in my head like he tries to do sometimes.  I always encourage him to write it all down. You know how it goes.  

So to be honest I am not sure. I sort of see the dyscalculia in the early issues, but I honestly think some of his issues now are more working memory issues than anything (and trying to do too much math in his head).  

But with his ADHD-inattentive it would probably be hard for me personally to note when the distraction is due to that inattentive element versus boredom. My best guess is that sometimes one is the engine and the other is the caboose and sometimes that reverses. 

Having one kiddo with a similar profile, this is difficult to deal with, IMO. I have an easier time with my child that has more severe issues, TBH. 

So, the keeping things in his head might be sort of a rushing through because if he doesn't rush, the insight that came like a flash will leave his brain. It's very much like kids who have speech issues that talk fast because it's easier to talk fast than to slow down and talk well. Yes, that's a working memory issue, but it can also be that he doesn't think he needs to write things down or that it helps much. Kids with ADHD often don't see cause/effect. Sometimes it's impulsivity or a lack of awareness, but sometimes it's that they experience a lot of variation in success/failure, and it makes them think what happens is largely by chance. When this is the case, it's hard to demonstrate that good practices are connected with good outcomes. It just seems random to them.

Boredom can mean craving novelty vs. things being too easy. It can mean that the task is not inherently rewarding (or that they haven't learned to value the reward themselves). It can mean that they aren't prioritizing things that are helpful for success, so they are "bored" attending to those details. As frustrating as I get with my son, he finds a lot of things boring that could be more meaningful to him. I would hate to be that way myself--he misses SO MUCH because things are not "shiny enough" to gain or hold his attention. He also drifts extremely fast, so any downtime at all, including in a conversation, and he's out. It's ridiculous.

Inattention can enhance that disconnect between effort and outcome, so the engine and caboose thing is real. 

2 hours ago, cintinative said:

Other than that, I had thought about using alarms as a way of a self-check (am I focusing? do I remember what I just read?).  How do you use alarms?

Being able to self-monitor is huge. I think a timer for that purpose is very reasonable. How is his ability to sense the passing of time? Does he estimate how long tasks take pretty well? Is his estimate different for rewarding vs. non-rewarding tasks? Does he tend to know what time of day it is at random times (either clock time or general things like morning, afternoon, early evening, bedtime? I know my son is terrible at this, and it does influence his perception. I once had him estimate how long a non-rewarding task would take. He was way off--he thought it was a LOT longer than it was. Then we set the timer for the amount of time it actually took, and I had him do something fun. He could not believe it was even close to the same amount of time that passed. We spent a day using that segment of time to do all kinds of things. I think I need to do that again. It was very informative for him to realize that he wasn't able to sense the passing of time, and that there was such a contrast between rewarding tasks/time and non-rewarding tasks/time. It must really skew how feels about things on a daily basis.

1 hour ago, Storygirl said:

Trouble with memorizing math facts often goes hand in hand with dyslexia, so that does not surprise me. DD16's school IEP allows her usage of a calculator; the idea is that understanding the concepts and how to do the problems is primary, and the calculator makes up for not being proficient with the memory. DD actually does okay, mostly, with remembering the steps to math problems, but when she had her neuropsych evaluation back when she was 10, the NP suggested as an accommodation having the steps to math problems on a reminder card that she could reference, as an accommodation for the working memory issues.

DD's tendency to rush is harder to accommodate 🙄. I think that is related to the impulse components of ADHD, and now that she's medicated (took a long time to get her a diagnosis, because teachers didn't see it), we're hoping the rushing will get better. You could talk to the doctor to see if a medication adjustment might help, in your son's situation. Sometimes one med, or an increase in the dosage, will work enough differently to improve functioning significantly. There are also some medications that can be added on (Strattera, for example, can be used along with other ADHD meds -- not promoting this; we don't even use it; it's just an example).

I agree with all of this. It's easier to discuss than implement, but it's spot on.

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https://www.amazon.com/FLIPP-Switch-Strengthen-Executive-Function/dp/1942197012

I haven't thought about it in a while, but this book has some good strategies. The trouble, for me, is that I don't "get" why they work (my brain needs to make things harder first), so I have a hard time introducing them well. One of my son's former tutors used some of them though--they made sense to her, so she was able to implement them well. 

 

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Posted (edited)
On 6/29/2021 at 3:49 PM, kbutton said:

https://www.amazon.com/FLIPP-Switch-Strengthen-Executive-Function/dp/1942197012

I haven't thought about it in a while, but this book has some good strategies. The trouble, for me, is that I don't "get" why they work (my brain needs to make things harder first), so I have a hard time introducing them well. One of my son's former tutors used some of them though--they made sense to her, so she was able to implement them well. 

 

The authors do OCALICON talks, etc. so you might find a youtube or powerpoint if you search. There's now a 2.0 version of the book I think. I went to one of the talks. It was pretty standard good stuff.

In the workshop they gave out printables so you could start applying it right away. https://flipptheswitch.org/resources/  It looks like they have printables and videos here.

Edited by PeterPan
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