WISC questions for an ADHD kiddo

[nature girl]

So I do recognize some names here, it's been awhile! I had my daughter home for K and 1st, she was in public school till 4th grade and then we brought her back home for 5th. She wanted to return to school for 6th, so we let her...She's struggled a bit behaviorally, and the school did thorough testing, both there and through a neuropsych to see if we should add ASD-1 to her ADHD. (It was inconclusive...Anyone who looked back on my old posts would see we've been struggling to figure this out for so long, I think she's just right on the edge.)

Anyway, they did a WISC, and these were her scores. I'm trying to understand what they mean...I guess I understand most of the spikiness, except for the relatively low digit-span (although I guess that means she's more visuospatial?) And does anyone know if the relatively low PSI and WMI (especially digit span) mean that her meds aren't optimized? Does the relatively low processing speed show her mind was wandering?

Also, do ASD-1 kids typically have high fluid reasoning? And...maybe a weird question, but any idea what I might do to nurture this? I want to boost her self-esteem, after a tough year at school, so for the summer I'd like to find puzzles or something similar that will make her feel proud of her skills. A lot of questions, I'm sorry! But thanks so much for any thoughts you might have!

 

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[Lecka]

All of her scores are pretty high.

No, high fluid reasoning wouldn’t generally be associated with autism.

I believe you there’s something that’s a problem but I don’t see it from these scores.  The digit span and coding are comparatively lower.

What wouldn’t be reflected are things like ADHD or anxiety?  Are things seen that suggest autism?  Nothing from these scores suggests it but that just means — well there are areas not reflected on this testing that could be suggesting it if it’s being mentioned.  
 

I remember her as such a sweet and creative kid 🙂

Edited June 26, 2022 by Lecka

[Lecka]

You honestly could post on Accelerated Learner with questions, people do.  

[nature girl]

3 minutes ago, Lecka said:

I remember her as such a sweet and creative kid 🙂

She really is! Thank you, Lecka.

I'm hesitant to post on Accelerated Learners since I think most of those kids' scores are far above hers. I don't think the higher scores are affecting her learning in any way, or at least not as much as her ADHD is.

The school wanted further testing because of some of her behaviors in class, social issues, what seems like possible TOM issues, and somewhat black and white thinking. She also was doing things they consider unacceptable, like pretending to be book characters and insisting she be called by their names, or wearing wings or masks she'd made while she walked through the hallways. 🙄 They did note some pragmatic issues in her testing, and in teacher scores as well. (The score labeled her as "at risk" for pragmatics.) They also said they sense anxiety, which mostly manifests as her perfectionism (which they thought brought down some of her scores, because she got upset and refused to answer if she wasn't 100% sure.)

But she doesn't really have sensory issues, other than some sensitivity to clothes, she doesn't mind changes to schedule, no stims, etc. She may be masking well, I don't know. And maybe I shouldn't even care, it probably doesn't matter at this level, except that I think she'd get more understanding from teachers if she had that label. I also would love to understand her better, be able to parse out which of her brain differences might be causing which behaviors, which might be under her control, and which we can work on.

[maize]

Honestly I don't think an IQ test can tell you anything about either ASD or ADHD. Her lowest scores aren't low enough to be concerning, even though they show "weakness" compared to her extremely high scores in other areas. One of my kids was in the 90's percentile-wise for most things, and in the single digits for processing speed. That was a much more significant spread!

Did the neuropsych do an ADOS? What autism -specific evaluations were done?

Have you read much about autism presentation in girls?

[Lawyer&Mom]

Off the charts visual spatial skills makes sense with Autism, but there isn’t a required WISC profile for Autism.  You really need a full neuropsych evaluation.  ADOS, memory, the whole works.  Find someone who is comfortable and experienced working with Autistic girls!

[KSera]

1 hour ago, maize said:

Honestly I don't think an IQ test can tell you anything about either ASD or ADHD. Her lowest scores aren't low enough to be concerning, even though they show "weakness" compared to her extremely high scores in other areas. One of my kids was in the 90's percentile-wise for most things, and in the single digits for processing speed. That was a much more significant spread!

Did the neuropsych do an ADOS? What autism -specific evaluations were done?

Have you read much about autism presentation in girls?

All this. I was expecting to see truly low processing speed scores, but those wouldn’t even make me blink. Seems like digit span might be the only thing that’s even multiple standard deviations apart from other scores? 
 

I agree with the others that I would see if she seems to fit the profile of many girls on the spectrum and if that might explain some of the things you’re seeing behaviorally. If so, there are plenty of autism pride type books and social clubs that might help her feel good about that part of her identity. 

[Megbo]

ASD and ADHD are diagnosed based on behaviour (measured by ADOS, rating scales, etc.) rather than cognitive scores and research trying to develop cognitive profiles for neurodevelopment disorders is all over the place (because of different subtypes, comorbidities, etc.), so I would try not to read too much into them in terms of a diagnosis.

The lower WMI and PSI don't mean that her meds aren't working well. The examiner should have mentioned in the report if there was anything unusual about how she behaved while doing those subtests, like if she lost focus in the middle or became fatigued. Most likely, she just has an average auditory working memory capacity and processing speed for her age - which would not be at all unusual for a gifted child with ADHD. Compared to their reasoning scores, all three of my boys have relatively low processing speed and two have relatively low auditory working memory. 

[Lawyer&Mom]

Lower auditory working memory is also consistent with Autism.  Auditory processing is typically one of our weaknesses.  I had rock bottom auditory memory (remembering lists of common household objects) and off the charts visual memory.  Like 2nd percentile vs. 99th percentile.

But it’s also not unusual for a non-autistic gifted kid to be spiky, and have some subtests that are just average. 

[EKS]

It's very common for gifted kids to have WMI and PSI scores in the average range. 

I think that the difference between the digit span and picture span subtests is very interesting.  Given that and her lower VCI, I'd be thinking about auditory processing difficulties and/or dyslexia.  Note that gifted with APD and dyslexia can look like both autism and ADHD.

Edited June 30, 2022 by EKS

[PeterPan]

14 hours ago, nature girl said:

ASD-1 to her ADHD. (It was inconclusive.

Did they do paper forms or an ADOS or both? Girls are so much trickier and it's something the psych community knows is happening, sigh. You should basically assume she is and do the interventions that are warranted. It's something that may become more obvious with time. Girls have a lot of coping skills and ability to mask. For intervention purposes, ADHD and ASD1 are thrown together anyway, so in that sense it doesn't matter. But just for your purposes, I suggest you assume she is, read, provide the supports you would if she had gotten that label, and let it sort out over time. When someone says inconclusive, sometimes that means they don't see enough girl autism to be really confident. Someone who sees a lot of girl autism isn't going to do that. 

1 hour ago, EKS said:

I'd be thinking about auditory processing difficulties and/or dyslexia. 

Yup, that's what I was thinking. The low digit spans but high visual working memory mean she's dropping when it goes all auditory. Maybe get a good eval for APD with an audiologist to see if there are any holes there. Look at the vocabulary scores. If it's not, that's cool, but that's what I would be looking at. My ds has scores a lot like your dd's btw. 

8 hours ago, Lawyer&Mom said:

gifted kid to be spiky, and have some subtests that are just average

I think that's always the challenge as the parent to know when it's just normal average and stop worrying vs. something significant. So for op, I'll just say that the significant spreads (20-40 points) in our house that didn't get much mention by the psych turned out to be harbingers of significant real life effects. Sometimes you don't see those till the demands increase. She's still young.

11 hours ago, nature girl said:

The school wanted further testing because of some of her behaviors in class, social issues, what seems like possible TOM issues, and somewhat black and white thinking. She also was doing things they consider unacceptable, like pretending to be book characters and insisting she be called by their names, or wearing wings or masks she'd made while she walked through the hallways.

The (remove lots of not nice words) neuropsych that failed to diagnose my ds with autism pulled a similar stunt, saying that the unusual things he was doing were because he was so gifted. Sure he had the IQ and prowess and drive to do what he was doing (memorizing large passages from audiobooks and reciting them verbatim) but we were seeing his autism, not just the IQ.

So I'm curious, what did the school want to change if she did get labeled ASD? The intervention should still be happening, no matter what the label. The evidence for that is very clear. If she has TOM issues, perspective taking issues, etc. then she does. In our district ASD1 doesn't even get you ASD as your disabling condition or even necessarily an IEP. Some of those kids are accessing their education with quirks, and their strengths make it such that they don't get intervention and supports. It's really unfortunate, because it's not like they don't NEED anything. It's just not messing up their ability to access their education so much that the school is compelled.

You end up needing to ask what you as a mom should make happen vs. what the school is going to make happen.

11 hours ago, nature girl said:

They also said they sense anxiety, which mostly manifests as her perfectionism (which they thought brought down some of her scores, because she got upset and refused to answer if she wasn't 100% sure.)

So they gave her an IEP for anxiety? They see it's affecting her ability to participate. Maybe all this funky costume stuff is her way of masking her anxiety. So they treat the autism and see what dies down. Have you treated the autism?

-interoception work--So she can realize how she feels, how others feel, and what makes her feel better, what her strategies need to be.

-meds (or genetics for supplements or...)

-cognitive strategies via counseling

All that is private because good luck getting the school to have someone ready to meet a gifted kid where they function. Everyone working with her on this should have a phd. OT probably won't, but counselors should. In my experience, the SLPs with a double masters (essentially a phd) can get there and the SLPs with a single masters often struggle any time they actually have to dig in and think. It's just reality, so you can't say oh the intervention wasn't necessary or couldn't work, because it was probably more the ability of the person to connect where they are. If it's not happening now, within the next few years it will. By middle/high school my dd was on to all phds and my ds is at that point (13) where I'm starting to drop people who are masters level. If the person doesn't think at that level, they tend to have really simplistic analysis that drives the kids crazy and doesn't hit where they're really thinking. Given that your dd underperformed, you should be looking for someone from the Hoagies Gifted list or someone with a phd. A lot of time in the ps and in private practice a masters level SLP is going to be tasked with doing social, and it's probably not your person, sorry. Be picky on this for better results.

11 hours ago, nature girl said:

They did note some pragmatic issues in her testing, and in teacher scores as well.

Pragmatics are such an interesting thing. It's kind of a big field but it includes some areas that are going to haunt her. The problem is right now the Social Thinking movement is so pervasive, top down, prescriptive, and you're a defective idiot based. That's what SLPs and anyone lower level is going to tend to do because it's easy (take a workshop, buy a book, boom). Think about what happens if you go the other direction, working on interoception (self awareness), to build her theory of OWN mind so she can eventually get to theory of OTHERS' minds. When you do that, all the other stuff comes into place more naturally. 

Remember, these challenges are not going away and are not smoothed by IQ. The unemployability in ASD with high IQ is HIGH. To get her quality of life good and her employability good, you want to build the skills that the school system doesn't care aren't there (self awareness and self advocacy that lead to others awareness and the ability to do all the things they're wanting to see happen).

https://www.kelly-mahler.com/live-online-courses/theory-of-own-mind/

11 hours ago, nature girl said:

But she doesn't really have sensory issues, other than some sensitivity to clothes, she doesn't mind changes to schedule, no stims, etc.

Maybe you're missing it. She's leaving low structure environments and going to higher structure, more predictable environments. She's wearing costumes to mask her stress when she's changing classes. If she has interoception deficits, she can't even explain yet to you what is stressing her out. You're SEEING the things that tick the boxes (difficulty with transitions, need for sameness, etc.) but not seeing it.

11 hours ago, nature girl said:

I think she'd get more understanding from teachers if she had that label.

Hogwash. People who treat people like crap do it because of who they are. Her diagnosis would be private and sharing it only opens her up to discrimination and more problems. Now maybe she'd get there eventually, but why should she need to share her private medical diagnosis to be accepted for something as HARMLESS as wearing preferred outfits each day?? People wear Goth, Emo, Nintendo, and all kinds of other stuff every day and expect to be accepted. 

The question about autism will become HER question eventually because she will realize she is different and want answers. The question about what changes at the school if she had it now is a good one. Per the training, there is zero reason to delay social thinking intervention and supports. She should not need that label to get them. 

I think what you're seeing is a super bright kid who can survive at school, meaning the school technically does nothing. You need to be asking what you need to do PRIVATELY to optimize her life, and for that you want an OT eval for the sensory with someone who is rocking interoception. You may need to work via tele to get that person, so I suggest trying the FB group. If you work that a bit, she'll have more awareness to self advocate and get the anxiety work going. The social growth will flow after that. If the anxiety makes it hard for her to do the interoception/OT work, you may need to work on the anxiety first. 

Remember, the school only has to do what is necessary to help her access her education. Everything else is private and falls on you.

11 hours ago, nature girl said:

I also would love to understand her better, be able to parse out which of her brain differences might be causing which behaviors, which might be under her control, and which we can work on.

You do the interoception work and she'll be able to tell you for herself. I would pair that with a phd counselor, someone with lots of experience with girl autism. Again, tele opens up so many options here. Don't think small, think MIND-BLOWING.

Edited June 26, 2022 by PeterPan

[PeterPan]

11 hours ago, nature girl said:

I think she'd get more understanding

The world is not a nice place. The label in the outside world isn't going to get you much either. It's sort of the toggle, because we talk acceptance but it's really about SELF-acceptance. We understand ourselves and how we tick and accept ourselves. The world still expects us to show some self-regulation, others' awareness, etc.

The challenge at that ASD1/ADHD/no label is that there is not always a "social pass." It's a concept they talk about in Social Thinking, the idea that people just naturally give some people a social pass and don't others. https://www.socialthinking.com/Articles?name=social-thinking-social-communication-profile  Here's an article exploring social thinking profiles. The "social pass" discriminates some of the profiles. A WISC for instance often does not get a social pass, and they have a lot more challenges, even with a less challenging presentation than say an ESC. The ESC gets the social pass because people just intuitively sense that that meant well and are functioning where they are. It's something to consider, because it's very hard to be on the receiving end of not getting a social pass for your social thinking deficits.

If I could suggest, it sounds like your dd *does* get a social pass. They're frustrated, but you, the school team, the professionals sense there are reasons. That should be very telling to you. 

So you need space to work through all this. It's hard if the psych wants to say xyz at a given age (which happened to us btw, btdt) and the people online are like nope, doesn't hold water. That's hard. But I'm just saying the world is not a nice place and it's not going to work to say well I just say she has autism and they'll be nice. Nope, doesn't work that way. She's going to need the intervention and self awareness to self advocate and self regulate. It's FINE to wear fairy clothes every day for the rest of her life!! That's cool and does NOT need to change. But her ability to say how she feels and be intentional and know why she's doing it and what makes her feel good and what she needs to feel good in a setting and eventually how others feel and how she can work with that, that's what needs to happen. 

It will come as you get connected with the right people. You can do this.

Edited June 26, 2022 by PeterPan

[PeterPan]

14 hours ago, nature girl said:

I want to boost her self-esteem, after a tough year at school,

Does she want to go back? Just wondering. You want her to be able to go back for the structure but she was also getting chewed up?

Self awareness leading to self advocacy and self regulation. That's where it's at. If she can say what she needs (which only she can say), the school will do it and you can advocate to make it happen. 

I make it sound so simple, lol. But high IQ, no language dropping? She can get there. Is her language dropping? Definitely how far she goes in self-advocating will reflect her support level. Just listening to how she functions, it seems like she has a lot of potential there.

Edited June 26, 2022 by PeterPan

[PeterPan]

11 hours ago, nature girl said:

brain differences might be causing which behaviors, which might be under her control, and which we can work on.

The problem is she can't control environment. It's not her fault the school works the way it does. She's still the kid. It's not her fault she doesn't understand herself yet well enough to self advocate. 

I wouldn't blame everything on her neurology, because reality is it's a rigid system not bent toward giving the intervention a higher functioning person NEEDS. 

 

Edited June 26, 2022 by PeterPan

[kbutton]

20 hours ago, Lawyer&Mom said:

Lower auditory working memory is also consistent with Autism.  Auditory processing is typically one of our weaknesses.  I had rock bottom auditory memory (remembering lists of common household objects) and off the charts visual memory.  Like 2nd percentile vs. 99th percentile.

But it’s also not unusual for a non-autistic gifted kid to be spiky, and have some subtests that are just average. 

I agree. This is run of the mill spiky. 😉

High nonverbal IQ can very much be an ASD presentation—it’s definitely the case for my 2e ASD kid. I think ASD kids vary a lot in their WISC patterns.

I think an APD assessment is a good idea, but my kid that can remember entire paragraphs he’s heard verbatim has no APD and has lower auditory working memory because the test gives contextless and meaningless info out for him to keep track of. Make it meaningful, and it sticks like glue. Forever.

Cute anecdote: the low WM kid in question knew I had asthma, and as a preschooler, he would hear a “commercial” on the local PBS about air quality—it was relevant because mom had asthma, so it stuck, and he related it to me verbatim after hearing it a time or two.