Understanding the various components that make up a neuropsychological evaluation!
Understanding the various components that make up a neuropsychological evaluation!
Understanding the various components that make up a neuropsychological evaluation!
“Is my child gifted? Is my child delayed? What is my child?”
“Gifted and ADHD, how can it be both?“
These, and similar questions were asked by parents of children who were eventually identified as twice-exceptional.
Twice-exceptional children are a misunderstood and under-identified group of children. Many educators, professionals, and parents are not familiar with this term and do not understand the challenges and experiences of these children. It “can feel so overwhelming that you do not know where to start,” stated a parent of several twice-exceptional children. The first step in helping this group of children is to understand what it means to be twice-exceptional.
What Does “Twice-Exceptional” Mean?
A twice-exceptional child is a child identified as being gifted and talented while also having one or more of the following challenges: a learning disability, a neurodevelopmental disorder, a social-emotional difficulty, or a mental illness (3). Unfortunately, there is no widely accepted definition of what it means to be twice-exceptional (2), in part because researchers can’t agree on how to define and measure giftedness. The second obstacle to defining twice-exceptionality is that learning disabilities, mental illness and social-emotional difficulties can encompass and manifest as a very wide range of developmental challenges.
According to the National Association for Gifted Children, a gifted child is defined as “a child who has an ability that is significantly above the norm for their age group, in one or more of the following areas: intellectual, creative, artistic, leadership, or in a specific academic area” (8). As stated by an administrator of a school for gifted children, “these kids’ capabilities outsize their bodies.” Because of their high intellectual ability, gifted children often develop unevenly – for example, their cognitive capabilities surpass their social or emotional skills. This mismatch in skills and abilities is referred to as “asynchronous development.”
Challenges in Development
As previously mentioned, a twice-exceptional child is a child who is gifted and experiences developmental or emotional challenges, such as a learning disability, a neurodevelopmental disorder, or a mental illness. A learning disability is defined as “a disorder in one or more basic psychological processes that may manifest itself as an imperfect ability in certain areas of learning, such as reading, written expression, or mathematics.” (7) Dyslexia, or specific learning disorder in reading, is one example of a learning disability, while ADHD and Autism Spectrum Disorder are examples of neurodevelopmental disorders that can impact both gifted and non-gifted children.
A social-emotional difficulty refers to a “condition in which behavior or emotional responses of an individual are so different from generally accepted norms, that they adversely affect that child’s performance.” (6) Many children experience social emotional difficulties at some point during their lives, yet for some it may have a negative impact on their academics, friendships, and home life. If a social-emotional difficulty persists and affects a child’s ability to function on a daily basis, it may meet criteria for a mental illness. Depression or generalized anxiety disorder are examples of mental illness that affect gifted and non-gifted children alike.
There is an abundance of information on specific learning disabilities, social-emotional difficulties, and mental illness. However, what is less understood is how these challenges interact with giftedness and how they manifest in gifted children.
There is a misconception among some people that gifted children are immune to challenges (5). One parent of a twice-exceptional child described this misconception in the following way: “People think that gifted children are the ones who can sit quietly and learn and do everything by themselves. Today we would think of someone being like Hermione Granger, someone who is constantly learning by herself and taking initiative to do more.” In reality, gifted children may be more vulnerable than their typical peers. This vulnerability can be partially explained by asynchronous development (4). A 10-year-old girl may concern herself with great societal problems, like homelessness or world peace; yet not have the emotional skills to cope with the feelings that these problems bring up. An 8-year-old boy gravitates towards peers that are several years older than him, but has to socialize with same-age peers in the classroom, and feels like he does not fit in. These types of internal and external mismatch makes gifted children prone to experiencing social-emotional difficulties.
The National Education Association estimates that 360,000 of students in the U.S. qualify to receive the label of twice-exceptional (1); however, this is most likely an under-estimation. Despite being exceptionally bright, gifted children may have learning disabilities that impact their ability to do well in school. In the early grades, they are often able to compensate for their learning challenges, which leads to a delay in recognizing the problem. For example, a gifted girl who struggles with reading may memorize a book and appear to read fluently; thus her reading disability goes unnoticed for some time. As gifted children become older and the workload increases, oftentimes they can no longer compensate successfully, prompting teachers and parents to finally recognize and address the problem.
Another roadblock to properly identifying a twice-exceptional child is the misconception that a child cannot be gifted if they have behavioral or attentional challenges. For example, people may think that a child who cannot sit still and finish an assignment could not possibly be gifted. On the other hand, giftedness can sometimes be used as a justification for problem behavior. For example if a gifted child is acting out — kicking his classmates, arguing with the teacher – people may think this is solely because he is bored or under-stimulated in the classroom. In reality, the child could have a true behavioral or emotional difficulty that needs to be addressed.
The first step in meeting the needs of a twice-exceptional child is to properly identify the child as being both gifted and having a particular developmental or emotional challenge. One parent of a twice-exceptional child encouraged parents to get a thorough neuropsychological evaluation: “not only does it help you understand your child, but the report also gives you the vocabulary to discuss this topic with teachers.” Once a child has been properly identified, parents can start the process of addressing his or her unique needs.
Supporting a Twice-Exceptional Child
Although little research currently exists on how to best support twice-exceptional children, based on our conversations with parents and educators, one of the most important factors is finding a “goodness of fit,” between the educational environment and the child. “Finding the right environment and staff helps make for a great year,” stated a parent of twice-exceptional children. With no federal mandate to provide services for gifted children, states and towns have to choose how to allocate limited resources within their education system. Massachusetts, where Growing Minds is located, is last in the country in providing funding and programming for gifted students. Schools do not always have the resources or the knowledge needed to address the complex needs of twice-exceptional children. Parents that we interviewed talked about their children having to change schools, sometimes more than once, in an attempt to find this “goodness of fit.”
Another important step in supporting twice-exceptional children is helping them understand how they learn best. Once the child has a solid understanding of her own learning style, she can use that knowledge to build on her strengths and to accommodate for her weaknesses. With this self-awareness, the child can learn to advocate for her needs. “We need to teach children to take ownership of their own and others’ needs without fear and shame, so that they know themselves and can self-advocate,” stated an educator of gifted and twice-exceptional children.
While we can teach children to become more self-aware and to advocate for themselves, we also need to educate professionals about the complex learning profiles of twice-exceptional children. As stated by one of the parents we interviewed, “you have to GET the child in order to meet their needs, but their needs are unpredictable.” In order to truly GET these children, more research has to address the needs of this population, and more training should be made available to educators and other professionals. As stated by an administrator of a school for gifted children, in order to address the needs of twice-exceptional children, we need to “inquire to understand with an open heart and a humble mind.”
We are deeply grateful to parents and educators of gifted and twice-exceptional children who agreed to be interviewed for this article.
This article was prepared with the invaluable help of Katelyn McKeighan, a second-year graduate student at Tufts University’s Eliot-Pearson Department of Child Study and Human Development. Katelyn is passionate about improving the lives of children and families with a developmental systems based framework. She will begin her Clinical Psychology doctoral program this coming fall with plans to be a clinical pediatric psychologist working with children and families navigating chronic illness.
(1) Assouline, S.G., & Whiteman, C.S. (2011). Twice-Exceptionality: Implications for School Psychologists in the Post-IDEA 2004 Era. Journal of Applied School Psychology, 27(4), 380-402.
(2) Reis, Sally M., Baum, Susan M., & Burke, Edith. (2014). An Operational Definition of Twice-Exceptional Learners: Implications and Applications. Gifted Child Quarterly, 58(3), 217-230.
(3) Ronksley-Pavia, M. (2015). A Model of Twice-Exceptionality: Explaining and Defining the Apparent Paradoxical Combination of Disability and Giftedness in Childhood. Journal for the Education of the Gifted, 38(3), 318-340.
(4) Silverman, L.K. (1997). The Construct of Asynchronous Development. Peabody Journal of Education, 72, 36-58.
(5) Webb, J. (2016). Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, Bipolar, OCD, Aspergers, Depression, and Other Disorders (2nd Edition). Anodyne, DBA Great Potential Press.
(6) What are Behavioural, Emotional and Social Difficulties (BESD)? (n.d.). Retrieved from https://sid.southampton.gov.uk/kb5/southampton/directory/advice.page?id=PgDcvquZbgE
(7) What Are Learning Disabilities? (2018, April 18). Retrieved from https://ldaamerica.org/advocacy/lda-position-papers/what-are-learning-disabilities/
(8) What is Giftedness? (n.d.). Retrieved from http://www.nagc.org/resources-publications/resources/what-giftedness
Have you ever wondered what IQ testing is all about? Has your child been tested, but you have questions about what the results mean? Our latest project, a three-part video series on cognitive testing, helps answer these questions.
It’s the middle of the school year.
Winter break has come and gone, and you and your child are back to the all too familiar arguments about completing their homework before any screen time.
The teacher has sent e-mails letting you know that the work isn’t being done and meetings have been held to try to resolve the issue. At home, behavior charts have been made, decisions on grounding have been enforced, and privileges have been taken away.
Despite all the effort that has been put into the situation, it doesn’t seem to be getting any better. When you tell your child that it is time to go do their homework, they explode. Your child starts throwing books on the ground, crumpling papers, and snapping pencils in half. Yelling matches ensue. You feel drained, and your child’s frustration seems to have reached a new threshold.
Before bed after a particularly intense quarrel, you decide to search the internet for something – anything – to help that you haven’t tried before. To your surprise (and relief), you find that many other parents have posted about situations that are similar to yours. Their children display explosive challenging behavior under certain circumstances, but are well-behaved at other times. One parent wrote about how they stumbled across the idea of lagging skills and Collaborative Problem Solving, and how it helped restore peace to their family. You are taken aback by how lagging skills describe areas where your child struggles, and decide that Collaborative Problem Solving just might be worth a shot… Continue reading Anger in Children: A Different Approach
Children who struggle to manage their anger lack the skills to do so effectively – this was the idea we introduced in the first article of this series. The term “lagging skills” was coined by Dr. Ross Greene in his book, The Explosive Child, and it’s key to understanding WHY a child is behaviorally challenging, as well as how to help them. (1)
Take a moment to think about children you know who are considered behaviorally challenging. They may or may not have an official mental health diagnosis. However, knowing the diagnosis may not help you understand WHY and WHEN those children have outbursts. A diagnosis can validate that a child is different and requires support, but it also directs your focus to challenging behaviors rather than the reasons behind those behaviors. Continue reading Anger in Children: A Shift in Perspective
My child will not turn the tablet off when asked – even after ample warnings about the amount of time left to use it. When I finally have to take it away, my child screams and starts throwing books and toys. It’s not uncommon for me to be hit and told that I’m being completely unfair. I’m so tired of having this fight over and over again.
My student will not transition from free play to the class meeting on the rug without an argument. When I try to reason with them, I get yelled at in response and the rest of the class gets riled up. I can’t go the rest of the school year like this.
Parents, teachers, and caregivers sometimes find themselves in these types of situations. Something comes up that angers a child, and despite the earnest efforts of the adult, the child appears to become more and more consumed by their feelings of anger until the situation gets out of control. Ultimately, the situation is upsetting and frustrating not only for the child, but for the adult as well.
“Anger is a natural emotion that alerts us when something has violated the natural order of how we think things should go (1).” Not only is it normal to feel anger, but it is one of our oldest and most primitive emotions. It’s hardwired in our brain from millions of years ago. Our prehistoric ancestors became angry whenever they felt threatened or disadvantaged. This served as a survival technique and gave our ancestors the motivation and drive to compete for food and mates. While we may no longer become angry to compete for a piece of meat (thank you, grocery stores), our brains still can’t stand being treated unfairly (9).
When we feel threatened, the part of the brain that controls our emotions, called the amygdala, is responsible for sounding an alarm. The amygdala is incredibly speedy at this responsibility – as little as a quarter of a second kind of speedy. It sends signals to other parts of the brain to prepare our body for action. Our heart and breathing rates increase, muscles tense up, body temperature and blood pressure rise. Stress hormones are released into our bloodstream, and blood flows to our limbs and extremities to prepare for physical action – our bodies are ready to fight (1)(4).
Nowadays, most times we don’t need to physically fight someone off when we’re angry. For example, when someone cuts you off in traffic and gets to go through a yellow light while you have to stop at the line as the light turns red, you become angry at the driver of the other car. You might want to scream, or even ram your car into theirs. Thankfully, split seconds after the amygdala sounds the alarm, the prefrontal cortex gets activated as well. The prefrontal cortex is the part of the brain that controls judgment and reasoning, and is responsible for determining how to respond to the triggering event that was recognized by the amygdala. This entire neurological response takes less than two seconds (3). Your prefrontal cortex tells you to take a deep breath, let it go, and keep driving.
The emotion of anger is present in human beings since infancy. Research shows that infants begin expressing anger during the last half of their first year due to the maturation of their cognitive abilities (9). Babies can become frustrated when an adult intervenes in an activity they are trying to do themselves, or when a favorite toy or object is taken away from them. At ages 3 and 4, having to share toys and personal space is a source of frustration. Increased expectations in kindergarten can result in anger (6).
As we explained earlier, our brains alert us when there is something to be angry about, then figure out how to respond to that trigger. In short, our brains are wired to react to an event before determining the sensibility and consequences of our actions. Learning to respond to our feelings of anger appropriately is a skill that has to be learned, not something we’re born knowing how to do. Thus, when babies get angry they respond by screaming and crying, and we have to do the anger management work for them. All through the toddler and preschool years, children are learning to manage their emotions (including anger) in socially acceptable ways. We help young children develop this skill by encouraging them to use their words, helping them identify their emotions, and providing them with strategies such as counting to 10 when angry.
“I know my son wants to make friends, but when he plays with others, the kids complain that he is being bossy.”
“My daughter came home from school and told me that she has no one to play with during recess.”
“I think my middle-schooler doesn’t know how to begin a conversation. He’ll say ‘Hello’ to his peers and then look down at his shoes.”
These children, along with many others, likely have trouble navigating social interactions. They may have difficulty understanding other people’s point of view and recognizing how their behaviors impact the way others feel about them. Although some of these children have specific disabilities, such as autism spectrum disorder, many typically developing children also struggle with mastering age-appropriate social skills.
We used to think that social ability was a fixed trait, and that some people were naturally better at navigating social interactions than others. Thanks to the pioneering work by Michelle Garcia Winner and her colleagues, we now know that social skills can be learned with guidance and repeated practice. The process called Social Thinking (1) helps people realize that during their interactions they have the power to affect the thoughts and feelings of others. In this article, we will explore the concept of Social Thinking further.
The term “gifted” can be misleading. Some people may think that since gifted children possess the special “gift” of high intelligence, they do not need any extra help and will succeed no matter what. This line of thinking does these children a disservice. While it is true that many gifted children do very well both academically and socially, it is important to remember that giftedness can bring with it its own set of social-emotional challenges that require understanding and ongoing support from adults. In this article, I discuss the challenges in navigating peer relationships that some gifted children face. I also explore possible ways to address these challenges. Continue reading Gifted Children: Navigating Peer Relationships
A middle school girl laments, “I really can’t make decisions. It’s very hard for me to make up my mind.” A ninth grader asks his teacher, “Can I start over?” as he erases all of his work. “I messed up on this problem.” A young adolescent boy explains, “I look at the amount of work I have and I feel overwhelmed. I just don’t know how to get started.”
These statements are common among adolescents with executive functioning difficulties. Executive functioning (EF) refers to the cognitive processes that are necessary to think, manage the self, evaluate and solve problems, and achieve goals (1). Adolescents with executive functioning difficulties often have trouble initiating, completing, or turning in their class assignments; they may struggle to stay engaged in lessons or classroom tasks. At times, these students may be labeled as ‘lazy,’ ‘forgetful,’ or ‘lost’ (2).
When the concept of executive functioning was first examined in the 1970s, it referred to the front of the brain acting as the control center or the “executive” (3) of the brain. Originally, executive functioning was defined as a concept that related closely to selective attention, or the ability to focus on one thing while blocking out distractions. In the past two decades, this notion has evolved. We now think of EF as consisting of numerous cognitive functions that are needed to assist with learning and self-regulation (3). The current research on executive functioning is summarized below.
“They never talked about how far ahead he was in reading or other subjects,” said one parent of her son’s experience in first grade. “They never named it. It seemed like there was an invisible line, and the teacher’s job was to make sure that all the students reached that line. But anything that was above that line, they just didn’t notice.”
The first step that parents and educators can take towards meeting the needs of a gifted child is to acknowledge that the child is gifted. With this acknowledgment should come the understanding that this child has unique cognitive, educational, and social-emotional needs. “It takes a while to come to the understanding that really, it is a question of needs,” says a parent of two children who have been identified as gifted. “It is not a question of wants; it is not a question of ‘it would be nice if…’. As a parent, you have to keep looking for opportunities to address their needs.” In the publication, A Nation Deceived: How schools hold back America’s brightest students, leading researchers in the field of gifted education, Colangelo, Assouline, and Gross (2004), agree. “Doing nothing is not the same as ‘do no harm,’ they write of educating gifted children. “The evidence indicates that when children’s academic and social needs are not met, the result is boredom and disengagement from school” (1).
In order to keep a gifted child excited about learning, parents and teachers must work together to figure out how to best meet the child’s academic needs. When appropriate, the child herself can also participate in this conversation. The goal of the conversation is to create an educational plan that would keep the child appropriately challenged and engaged in the learning process.