The Problems of Misdiagnosis

A lack of understanding of the full range of characteristics of gifted children (and adults) by parents, professionals and teachers can often lead to the misdiagnosis of learning difficulties. The problem with misdiagnosis is that the 'treatment' or strategies employed are not effective in helping the child and  the real reason for the difficulty is ignored. This can often make things worse and lead to frustration and depression.

Many characteristics that are inherent to gifted children can be misinterpreted as a learning difficulties.  It is important to realise that many of the 'problems' or behaviours that concern parents and teachers are not actually problems for the child themselves but are the result of unrealistic expectations or a mismatch between the child and the environment they are in.  This is probably one of the reasons parents and teachers can often view a child quite differently.  

At home the parents often adapt the environment to suit their child.  Although they may receive criticism from friends and extended family, in many cases it is simply a case of survival as a family or a parent. For me, my son was like a 'force of nature' from the moment he was born, he was impossible to ignore. He was interested in anything and everything and he never kept still.  He also didn't like to sleep. It is exhausting to clash with your child numerous times everyday. And why should we? Our children's demands are normally not 'bad' just 'unusual.' We have our child happiness and well being at heart.  So if this means reading two pages of the encyclopedia to your two year old every night, as I did, we will do it.  Many parents also recognise themselves in their child and so are more willing to make concessions to aid family harmony.

In school however there is a very different agenda, most schools want children to conform and look for what they consider to be 'good learning behaviours'.  Listening to the teacher, sitting still, completing tasks as the teacher asked in a timely fashion, cooperating with their peers are just a few.  However most of these simply do not match with a typical gifted profile.  Gifted students don't want to listen, they want to find out for themselves or ask the questions. They can struggle to sit still as their active mind demands action. They often have unique ways of viewing things and will often adapt a task to make it more complicated or interesting. They may get distracted by other ideas and not complete the task in time. They may find it hard to work with other children who have such different interests and views. 

One the main characteristics of gifted children is their intensity or 'overexcitabilities'.  Polish psychologist Kazimierz Dabroswki developed the idea of overexcitabilities as he studied the characteristics of gifted children.  He suggested that there are 5 main areas: psychomotor, sensual, intellectual, emotional and imaginational. Most gifted children and adults will have one main area but they may also have multiple intensities.  As I discuss these intensities it is easy to see how they can be confused with the characteristics of various learning difficulties.

Many gifted students are hyper aware of their surroundings and can be overly sensitive to sound, light, visuals, touch, smell, taste and textures. This can make the typical classroom environment very distracting.  The colours, visuals, sounds and bright lights can feel overwhelming to some children and make it impossible to focus on the task in hand.  Even as an adult I find my eye drawn to patterns or bright colours on a display and I get distracted from the conversation I am having.  Teachers should consider who the displays are actually for and whether they really enhance the learning experience for children.  School uniform can be another distraction, if the fabric or labels 'rub' or irritate. A child may avoid a particular room or area of school because of particular smells.  Lunches can also be difficult for some children who are very sensitive to taste and texture. Packed lunches and school dinners are not the same as the food a child has at home.  Picky eating can lead to low blood sugar which in turn can lead to distractability or emotional outbursts. Playgrounds can also feel uncomfortable with the noise and constant movement. These sensitivities are often associated with autism and again can lead to a misdiagnosis.

Those children with psychmotor intensities have an intense need to move. They love movement and have endless energy. They will often speak rapidly, fidget and want to take immediate action. The slowness of the classroom and the need to sit and listen to the teacher can be hard to bear. They are excited by learning and just want to get on and do it! This excessive movement and spontaneity can often be mistaken for ADHD as many of the characteristics overlap. Although the cause and solution for gifted students can be quite different. I will discuss this further in a future article.

Some children with intellectual  intensity have a mind like pin ball machine where they are being constantly bombarded with different thoughts and ideas. Sometimes this is referred to as a 'rainforest mind' and there are useful websites that discuss this further. It can be very hard for children to filter and prioritise these thoughts making it hard to focus in class. Particularly if work in class is very routine and unchallenging. Students may want to act on their own ideas or may be intellectually excited by a new idea, causing excessive movement. Again the student can seem distracted and too active, leading to suggestions of ADHD.  The child's area or areas of intellectual passion may not relate to the school curriculum at all and may not even be discussed or acknowledged within the school context.  This very hard for a child who is literally bursting to share their new found knowledge.  When my son was in Nursery school he avidly watched 'Time Team' and would pretend to find Roman artefacts in the garden. One morning he asked me if the Egyptians had hypocausts like the Romans. But at school he was supposed to colour pictures and pretend to be an aeroplane with the other boys. Even as a Primary school teacher I was not prepared for the stark mismatch between what he did at home and what he was allowed to do at school. Many schools and teachers are equally unprepared for children with intellectual intensities.

There are no easy solutions for the mismatch between home and school. An honest and open dialogue is the best place to start. Many teachers have not had adequate training in giftedness to realise a child who is not conforming may be gifted rather than 'difficult'.  In my next article I will talk about how to  approach a school and talk to teachers about your gifted child.

www.verywell.com and www.rainforestmind.com have a wealth of useful advice and articles

 

Twice Exceptional - what does it mean?

Is she gifted?

Is he gifted?

Many people are unaware that gifted students can have learning difficulties. 



They still have the narrow view that gifted students are 'straight A' students who breeze through school.  It is probably one of the reasons that many teachers are reluctant to give any extra attention to gifted students, after all school is so easy for them!  There is also resentment from other parents as they feel the gifted student has an unfair advantage over their child.

It is not uncommon for gifted students to be dyslexic or autistic or have ADHD or a whole range of learning difficulties. The difficulty is that giftedness can mask the learning difficulties as bright children can often find ways to compensate for their difficulties.  On the other hand sometimes the learning difficulties masks the giftedness as teachers and adults focus on the behaviours and deficits rather than he child's abilities.

To add to the confusion gifted children also have overexcitabilites which can be misinterpreted as a learning difficulty like ADHD. They can be perfectionists, be rigid in their thinking and have difficulty socialising within their own age group which can be mistaken for autism. Their asychronous development can also mean that their motor skills and writing skills do not match their intellectual ability and can seem like a dyslexic type difficulty.

The result of these uneven profiles is that many gifted students are never recognised as 'gifted' within the school context.  Their parents will see how rapidly they learn new things at home, their extreme curiosity and hunger understand the word around them, their advanced vocabulary and heightened sensitivity and awareness.

But at school, the teachers are unimpressed - they complain about the child being distracted, not listening to instructions, rushing to complete tasks, not completing written tasks carefully. They are frustrated that the child seems to want to follow their own agenda rather than dutifully completing the task as the teacher instructed.

And so the journey of disappointments, frustrations and misunderstanding begins for the child, the parents and the teacher.

As a parent and a teacher I can see both sides of the story. I understand why teachers behave in the way they do, as they rely on children's responses to a narrow range of activities in the classroom.  But I also know the frustration when teachers do not see your child as you see them and they do not value your insights from your experiences at home.

The best way to identify twice exceptional children is for there to be an open and honest dialogue between teachers and parents.

The missing part of the puzzle is very often information that only the parent will have. There needs to be an acceptance that if a parent says their child is gifted the chances are that they are gifted. I don't even like the word 'gifted', I don't use it to boast, I use it because it the most helpful way of understanding my child.  I find that very often my motives are questioned when I draw a teacher's attention to my child's abilities. Like all parents the well being of my child is my main concern, its not about 'status' or having unrealistic expectations. In fact I spend most of my time keeping quiet about my child's abilities with both friends and family.

Parents often see a different side of their child which may not be obvious in school.  Teachers should not forget that parents have been observing their child from the day they were born and are quick to notice when their child does not behave or react to things in the way other children do. Often parents will spend many years puzzling and piecing together observations and researching possible causes for their child's difference. Parents know things about their child that teachers would never know from the school context. And just as many adults have a work persona and a home persona, children can present very differently at home and at school. Teachers need to value a parent's insights more and think about how it relates to the child they see in school.

In my experience, teacher's can often misinterpret a child's behaviour or shortcomings and the reason for these difficulties. They often blame parents when actually those things are very intrinsic to the child. And no amount of correction or persuasion will change it.  My child is a perfectionist and no matter how many times I tell him it is ok to make a mistake, he still cries or gets angry when he does.

From a teacher's point of view, many have not had training about how giftedness may present itself in the classroom or the full range of gifted children they may come across.  They are trained to value and judge a child's ability by how successfully they complete routine classroom tasks. There continues to be a big emphasis on what a child can record in writing.  This can lead some gifted children to be grouped with 'lower' ability children because they are easily distracted or their writing is weak. Of course gifted students do need to learn to focus and improve their writing skills if this is an issue.  But if we put all the focus on  child's weaknesses and do not acknowledge or give time for them to be challenged or excel in their area of strength, this leads to frustration and demotivation. Which in turn can lead to behaviours which further distracts the teacher from the giftedness and a downward spiral begins.

Well informed teachers and parents are the key to the success of gifted students and particularly those who are twice exceptional.

Over the next few weeks I will be discussing the full range of twice exceptional students and the dangers of misdiagnosis.

Book of the week - Helping children with dyslexia by Liz Dunoon

Realising that your child may be dyslexic can be daunting as a parent, this book will help you make sense of this difficulty and know how to move forward.

"This book will show you how to ensure your child's success at school and in life. It provides a complete guide for parents and teachers to help children with learning difficulties in particular, dyslexia. ‘Helping Children With Dyslexia’ has helped thousands of families to navigate and overcome the barriers preventing their child from doing well at school. It provides the latest research and strategies from some of the worlds leading dyslexia experts as well as advice from parents who have children with learning difficulties. You will learn how to tell if your child is dyslexic, find the right school for your child, choose the right remedial programs, identify their strengths, build their confidence and work with the education system to help them achieve learning success." Amazon UK

Liz Dunoon has an excellent website Dyslexia Daily with advice and resources for parents and teachers.

Supporting working memory difficulties

Working memory difficulties affect many students and is the common challenge for many common learning differences like Dyslexia, ADHD and ASC.

Overcoming working memory difficulties can seem daunting at first and it certainly takes time and persistence to make any in roads.

For the open minded teacher there is a lot that can be done within their lesson delivery to help and support children who have working memory difficulties

1. One key thing is to make it acceptable to ask for instructions to be repeated.  As I explained in my last article working memory is limited and when it is overloaded the information is lost and can not be retrieved. If we get cross with a child for not listening we do not help the problem, we only force then to develop unhelpful strategies like copying or work avoidance.

2. Making information available as an individual paper copy using visuals, notes or bullet points is extremely helpful. This will give the child something to help them to focus and keep track of what is being said. Many teachers think it is enough to have the information on the white board but this can be just as inaccessible to a dyslexic child as the verbal information.

3. The teacher can prompt the child prior to the lesson about what to listen out for or ask them a specific question.  For example 'Today I am going to be talking about mammals, listen out for one of their characteristics" This encourages both active listening and encourages the child to listen out and filter what it said for key words rather trying listen to everything and becoming overloaded.

4. Preteaching of some concepts with concrete materials, using discovery learning or visuals may then give a child a chance to tune in and participate rather than swimming in a sea of words. We  know from our own experiences it is much easier to follow a conversation when we already know the subject matter.  If we join a conversation where people are talking about something unfamiliar it can take some time to tune in and we may even misunderstand initially.

Most teachers love to talk but often don't appreciate how much they say with out using visuals or resources to illustrate what they are saying.


5. Repeating instructions with a reduction of words increases the chance children with poor working memory retaining the whole instruction. The teacher can encourage the whole class to count and repeat the key words on their fingers and ask some children to repeat back what has been said.

6. Setting up class routines reduces the number of instructions that a child has to listen to and process. This leaves more energy for actual learning. 

For the child there are ways of training themselves to remember more of any information given verbally.

1. One of the most effective methods is encouraging children to verbalise what has been said out loud, it can be under their breath or in a quiet voice.  As the child says it they have an addition chance to process the words and pick out the key words.  Research has also found that we remember things said with our own voice more readily.

2. Children can be taught to visualise what is being said, again this needs training outside the classroom. If the child actively listens and creates a mental picture of what is being said it becomes more memorable.  Exaggerating the picture or making it funny can also help. 

Mnemonics for spellings and number facts can make use of both verbalising and visualising.

Some children need a structured programme, a speech therapist may be key in this delivering this. There is a well established programme called 'Visualizing and Verbalizing'
see http://lindamoodbell.com/program/visualizing-and-verbalizing-program for more information.

Older children can be trained to make notes and pick out key words, but this does need adult modeling first and practice outside the classroom.  Contrary to common belief, note taking is not an easy skill to master and it does need teaching. It also needs to taught a step at a time, first children need to work on listening to a sentence and picking out the key word or idea. They may need to discuss with an adult what makes a key word. It will take practice to filter out the extra words and focus in on the key word. Then they need to practice saying the key word to themselves and only writing this down. Dyslexic children can find it very hard to listen and write at the same time, drawings and diagrams can be a way round this. It may take several months to learn effective note taking.

At home, encouraging eye contact when speaking can help. Children often find it hard to divide their attention, if they are involved in other activities they may not actually be listening at all. This is often the cause of parental frustration and the need to repeat instructions again and again.  Asking your child to immediately repeat back what you have said can also be helpful in ensuring what you said has been heard and understood.

Again establishing routines and checklists can help.  Sometimes parents can be reluctant to use checklists at home as they want to be more relaxed and different from school. But as adults most of us rely to diaries, lists and written instructions so that we do not forget steps in a task or a series of jobs that need to be done.  Children need to be introduced strategies which will encourage them to be independent rather than needing adult prompting to remember.

All in all plenty of PATIENCE is needed as it takes time, encouragement and training to overcome working memory difficulties.

Book of the week - Understanding Working Memory

These are 2 excellent books for understanding working memory.
Working memory difficulties have a huge impact on dyslexic children, yet many parents and teachers do not really understand what it really is. These books offer some interesting insights and practical advice for supporting children with working memory difficulties.

Tracy Packiam Alloway has been involved extensive research into the area of Working memory, for further reading go to www.tracyalloway.com