Expert: Ettina - 11/9/2009

Question
QUESTION: I have an 8 year old son who doesn't like to go to school. i have read some articles on the site and was wondering if he is gifted or there are some disorders.
My son was very small at birth. He actually almost died and was very cold when he was born. Nevertheless he was very aware of his surrounding. The first thing he did at birth was looking around and as soon as he saw me, he smiled. The doctor had to slap him twice to get him crying.

He was a couple of days old as I saw him looking at me in a strange way. It was as if he was telling me a message with his eyes. He never did things that babies do (e.g.: putting all kind of stuff in their mouth#. As a baby he observed patterns, colors, objects, etc. With 7 months he started to speak. With 10 months he could already speak sentences clear enough for everyone to understand. He never talked using baby words #dada, etc.# When he hears a word he repeats it without any mistake. At age 1,5 he new the whole alphabet. At age 3 he could count up to 100 in Dutch #our mother tongue# and up to 10 in English, Papiamentu #similar to Spanish# and French. He never was interested in painting, coloring, and writing. He always wanted to play with his cars. He was interested in reading and could read at age 5.
At age 3,5/4 I noticed that he wasn't able to speak up what he wanted to say and takes very long to make a sentence. He always wanted to go to school and when he started at age 4, he immediately lost interest into going to school #after the first school day already#. Since then it's a big struggle every morning. It takes him forever to brush his teeth and eat. Doing homework is a daymare because he takes so long to make it. I tried to explain him that it's important to learn but he says school is so boring. He concentrates really bad at school #and doing homework too# and seems to forget everything is said at school #especially regarding homework#. I have to repeat myself constantly because he always forgets what I've told him. Also routine stuff like wake up, brush your teeth, put your clothes on and eat, I have to tell him over and over every day.
He has been tested on ADD/ADHD and dyslexia but all is negative. We send him to a concentration training and they also couldn't find anything wrong. If he has to play concentration games on the computer #e.g. rush hour), he has no problem at all playing it for hours. I have no clue of what is going on with my son and how I can help him. Please if you can give me some answer I highly appreciate it.

ANSWER: Firstly, your son is pretty clearly a gifted child. However, it's possible that he has some sort of learning problem in addition to giftedness, particularly since he had a rough birth.
I'm not entirely sure what's going on with your son, but I sort of get the impression of a quiet, slow-moving, inactive child. Is that right? If so, that could mean one of two things.
Firstly, he might have sensory processing differences, particularly hyposensitivity. Whereas many hyposensitive kids are sensation-seekers (hyperactive, intrusive, risk-taking, etc), others just don't react very strongly to most sensations. Occupational therapists can assess sensory processing and give advice on how to help the child. In general, with hyposensitive kids, the advice is usually to provide some sort of strong stimulation such as a massage, or getting them to carry or push something heavy, in order to 'wake up' their sensory processing.
Another possibility is slow processing. Different kids generally tend to take more or less time to process something, and this isn't necessarily related to intelligence. Basically, a kid with slow processing is fine at understanding and responding to things, but you need to give them a bit more time. When you give them information too quickly, they typically get overwhelmed and tune out.
I'd need more information to know whether my suggestions are accurate or not.

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QUESTION: Dear Ettina,
Thanks for your answer. Your first impression is not completely right. He is not an inactive child; on the contrary, he only wants to play and when playing, he makes noises (e.g. airplane, car, rocket noises). He loves to help cooking (he can make rice porridge on his own) and picking up heavy stuff since he thinks he is very strong:-) but he has problems telling what he feels (not always though) or thinks.
The second suggestion, I immediately got the feeling that it could be the problem since he always tells me that I speak too fast and he cannot clearly hear what I say. I have to repeat myself and when I speak slowly he understands it immediately but doesn't get him going into doing what he's supposed to do.
I spoke to a teacher today and she suggested "Vision Therapy" which he has been having already (7 months) because his brain cannot fit the images together so that he gets one clear image.
The person who gave my son the concentration training said that my son is probably not being challenged enough in the class and therefore he is not motivated. I don't know what to think about this because my son is saying that everything in school is boring and he doesn't like doing homework because he knows it all already (repeated subjects). But he often doesn't remember the stuff and even simple things would take him some time (e.g. 20+20; in first grade he had problems with 1+1). This is not always the case though; he only has it at times, especially when he is tired.
If there is any other information you want, I'll be glad to give it to you. Thanks in advance

ANSWER: OK, yeah, he's probably not a hyposensitive kid. Slow processing sounds like a better explanation.
In terms of kids claiming that schoolwork is too easy while not doing well, there are a few different explanations:
a) Firstly, of course, some kids are just trying to save face, and actually find the schoolwork too hard. Kids who are struggling in school experience a fairly heavy blow to their self esteems as a result, and will often try all sorts of methods to feel better about themselves.
b) Secondly, it could be that some parts of it are too easy and other parts are hard, which is the typical experience of a gifted/learning disabled child. This usually results in a lot of scatter in performance, even within subjects. For example, a dyslexic kid might do a math sheet just fine but have trouble with word problems, or an extremely visuospatial learner could do excellent in geometry but very poorly in algebra.
c) Lastly, it could be doing work that's hard for the kid, while the actual content of the work is easy. Often times people say 'if you try harder, you won't have any trouble' - well, for some kids, that's like saying 'if you see better, you won't be blind'. Basically, some kids have a disability affecting their ability to exert effort, referred to as 'executive dysfunction'. This can result in the child's effort, and therefore performance, varying wildly depending on interest, mood, the presence or absence of external cues, and a wide variety of other factors, because the kid isn't able to push themselves when the internal motivation isn't there. One common problem, particularly with gifted kids who have this disability, is that doing really easy work is actually harder because the lack of challenge means the kid's not interested in the work. And this problem tends to get worse when the kid is tired, because for one thing they get less motivated to do anything when tired, and in addition most of these kids can push themselves, but it's harder than it is for most people - and tiredness interferes with your ability to do anything hard.

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QUESTION: The explanations b) or c) could be the answer but how do I help him if he got a learning dissability or doesn't have the internal motivation? And what could be the reason for him having a dissability?
Recently we did a MRI scan and it showed that his brain structure is fine. I actually wanted to do a fMRI scan but where we live isn't possible. I am still trying to get the fMRI scan done but would this reveal the cause of the problem? How can I know for sure what the problem is?
Many Thanks

Answer
The cause of learning disabilities and executive dysfunction remain unknown in all but a small minority of cases. There is some research suggesting that kids with executive dysfunction show reduced frontal lobe activity on fMRI, but this research is still in the early stages and fMRI is not considered a diagnostic tool for executive dysfunction or learning disabilities.
The best way to tell if your child has a learning disability or executive dysfunction is to get him a psychoeducational assessment. This is especially good for identifying learning disabilities. Basically, a psychologist administers a bunch of IQ, academic and cognitive tests to determine the child's strengths and weaknesses and ascertain if the child has some sort of neurodevelopmental disability. This would also confirm whether or not your son is gifted.
In terms of how to help, if your son has a learning disability, the first step is to figure out exactly what his strengths and weaknesses are (which is where a psychoeducational assessment helps). Once you've determined that, there are two different strategies which are used to help with this.
Firstly, the teacher can modify assignments to circumvent areas of weakness and/or tap areas of strength to compensate, which is typically done when the difficulty area isn't central to the subject of the assignment (for example, when dyslexia interferes with completing math assignments). If the difficulty area is central to the subject matter, such as a dyslexic child doing a spelling assignment, then instead of accommodation the technique used is remediation, which means giving the kid simpler assignments, more practice, and often multiple different ways of teaching the same skills. For the most part, both of these are the teacher's job, although parents can certainly help.
With executive dysfunction, the same general principle applies, in that you'll be both trying to keep this difficulty from interfering with assignments and trying to help the kid get better at managing their own work. However, parents are much more crucial with this condition because this condition affects homework much more than schoolwork and causes problems in areas unrelated to school as well (such as cleaning their room, dealing with social interaction, and in adulthood managing a household). And the remediation consists mostly of teaching the kid to provide accomodations for themselves instead of depending on others.
Accomodations for executive dysfunction basically consist of setting up the environment so that it's conducive to doing whatever needs to be done. Reminders are one of the simplest ways of doing this (I use a beeping watch to help me get to class on time, for example), and are helpful to some degree for just about everyone with executive dysfunction. However, often they're not enough. The other accomodations are different for each individual, but can include:
a) doing schoolwork at a particular place and/or time, so that just being there at that time put the person in the right mental state for work
b) conversely, recognizing when the person can do whatever it is and postponing less important things in order to do it (which is what I do to write papers in university)
c) changing the assignment so that the person's more interested (this especially works with kids with very intense interests in specific areas, such as autistic kids)
d) doing something before starting work to get in the right frame of mind (for example, most of my ideas for writing come to me while I'm walking and/or talking, so when I'm stuck I'll get up and pace around talking to myself)
e) putting in place whatever background stimulation helps the person concentrate, such as setting music to play, finding a comfortable position, etc (this is very individual, and the same things that help one person concentrate can be quite distracting for someone else)
f) just notice in what situations he does the work, and figure out how those situations differ from when he doesn't do the work