Gifted Children And What It Means To Be Advanced

gifted childI was asked to write a blog on giftedness in children – specifically, how to access it and how to ensure that a child with cognitive strength is able to reach his or her potential. This has proven to be a hard topic to write about. I don’t like the term “giftedness” for several reasons, but before I divulge those, I need to discuss what it means to be “gifted.”

A quick review of basic statistics is necessary in order to understand how we assess children has demonstrating superior ability. Traditionally, when we think of giftedness, we are thinking of a child’s IQ score. The vast majority of IQ scores used standard scores. A standard score is a statistical term in which a score of 100 is solidly average (50th percentile) and a standard deviation (the spread of scores from the mean of 100) of 15. In layman terms, scores between 85-115 are considered to be average.

When you are talking about giftedness, we see scores with at least two standard deviations greater than the mean (meaning an IQ score of 130 or higher). So, gifted children are those children that have IQ scores of 130 or higher. Pretty easy to identify, right? Wrong. One of my major critiques of giftedness is that parents and some academic folk rely way too much on the overall IQ score to determine if a child is gifted.

What Are IQ Measurements For Children?

The current gold-standard IQ measure, the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) came out in 2003. On the WISC-IV, children attain a Full Scale IQ score, which is comprised of several factors: verbal reasoning and comprehension, nonverbal reasoning, immediate attention and memory, and processing speed. Here lies one of the concerns in assessing giftedness. Which score should one use? Read more

The Oprah Winfrey and Sensory Processing Disorder Controversy

There has been a loud voice from many people who advocate for sensory processing disorder (SPD) after a segment on the Oprah Show which aired on Friday February 18th, about a seven year old boy with multiple mental health diagnoses, one including sensory processing disorder.  http://www.oprah.com/oprahshow/Children-Dealing-with-Violent-Rage/1

What The Oprah Show and SPD Commotion Was All About: Oprah Show

Many advocates have voiced concern that sensory processing disorder has been misrepresented on the show, leading viewers to believe that a child with SPD is violent, aggressive and gets pleasure from events that may cause pain for others. I do not believe this was the intention of the family or the show, but it still may have been perceived as such.

The explanation from Oprah’s summary on her website states SPD is “a condition which alters the way one processes stimuli- sound, touch, smell- from the world”. The mother does explain that Zach has a combination of hypersensitivity and hyposensitivity and that he would do things like throw his body on the ground and would get pleasure and laugh when other children would be hurt. His mother also explains that sounds, light and clothing bother him.

Why Sensory Processing Disorder Advocates Were Upset With The Oprah Episode:

I understand the focus of the episode is about this young boy’s tragic story and his family’s struggles through their journey, not to focus on defining sensory processing disorder because let’s face it, SPD can not be simply summed up in one sentence, but this is such a simple explanation for such a complex diagnosis. There was no explanation of which diagnosis affected the boy in which ways, what diagnosis medication was given for, the different patterns of SPD or how it may present differently in each child that has SPD. The show also does not mention that SPD can affect movement, social skills, posture, participation in daily activities, fine motor skills, attention or even school performance. SPD may affect one or two areas of one child’s life or just about every aspect of someone’s life including their entire family’s dynamic. There was no discussion of how SPD is treated or what treatment consists of.

I think it’s great that the not-so-well known disorder is getting national recognition on a well-trusted show such as Oprah, even though it may have been brief and unclear. However, like I mentioned above, this was not, nor should have been, the focus of the show. The many responses to the episode just demonstrate a need for continual advocacy and education for sensory processing disorder. My hope is that SPD will be more accurately represented and understood in the future, as more media coverage completes stories on those affected by the disorder.

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I would love to hear your opinion on the show!

When To Screen Children For Autism And Other Pervasive Developmental Disorders

Popular media is now teeming with stories about the dramatic rise in autism. Several celebrities have spoken publicly and advocated for increased research on assessment methods and treatment options. Parents are now more keenly aware of even minor deviations in their child’s developmental milestones, and they worry that these delays could be the first signs of a debilitating life-long disorder.

With all of the increased attention being paid to autism, many families wonder how to make sense of the myriad checklists and screening tools available online. In addition, parents struggle to decide if their child’s repetitive behaviors and singular fascination with toys and movies are age-appropriate.

The worry is not just paranoia – researchers have repeatedly concluded that early intervention leads to optimal outcomes for children with autism and other pervasive developmental disorders. To determine whether or not to call your pediatrician, you can look at the key variables that clinicians use in assessing autism..Below are some factors we look for when evaluating a young child (2 to 4 years old).

6 Factors To Look For When Exploring A Possible Autism Diagnosis

1. Shared Interest

Children will begin to develop this skill at around 10 to 12 months of age. Essentially, shared interest is the child’s strong desire to share emotional feelings with others. After this age, when children are confronted with novel and exciting stimuli (bubbles, balloons, etc.) they frequently look from the stimuli to their parents and back. While seeming to be a simple action, this reflects a child’s social connection to their parent and desire to engage them. The absence of this reaction is reason for concern. Read more

All You Need To Know About Learning Disabilities

How common are Learning Disabilities?

LD Boy

Learning concerns are one the most common neurological issues that children and adolescents present with. It has been estimated that approximately 20% of the general population in the prevalence rates indicate that 6% of the general population meet the necessary diagnostic criteria for a diagnosis of a specific learning disorder.

How are Learning Disabilities Defined?

There is great debate regarding how to accurate define, classify, and diagnosis learning disorders. Traditionally, it was assumed that a specific learning disorder exists when there is a significant discrepancy between a child’s ability (IQ, cognitive functioning) and achievement (performance on standardized reading, mathematics, and written expression tasks). However, there have been recent changes within the USA regarding how to classify and diagnosis learning disabilities. Currently, categorization of a child’s learning disability is based upon a multi-tiered process involving early identification and intervention. This multi-tiered process based approach is labeled Response to Intervention (RTI).

What are the Pros and Cons of RTI?

Researchers who are in favor of the RTI Model of learning disabilities argue that a combination of interviewing and behavioral observations are sufficient for identification of problems as well as to determine appropriate interventions. The RTI Model is most beneficial for children who have emotional or behavioral disorders that result secondary from a defined environmental factor, such as: inappropriate or inconsistent reinforcement or punishment. Read more

Sleep Disorders in Children

sleeping childMost families think of nighttime as a period of respite from daily activities of their children, a chance to reconnect with their spouse, relax and unwind. However, for families who are dealing with sleep issues in their children, nighttime is often one of the most difficult and challenging times of their day. Children who have difficulties falling asleep, staying asleep or disorders that disrupt the quality/quantity of their sleep end up with families who are also tired and miserable. Thus, promoting healthy sleep habits and effectively treating sleep disorders in children is often one of the best ways to improve a family’s overall quality of life.

Effects of Sleep Disorders in Children

With the advent of physiological procedures for evaluating sleep, we have gained a better understanding of the role of sleep in children. While children suffer from several of the same issues that effect adults (sleep apnea, restless legs, circadian rhythm disorders and insomnia), the causes and treatments of these conditions in children are often quite different. In addition, the daytime effects of disordered sleep in children are quite different from adults. For example, sleep disordered breathing such as apnea and chronic snoring lead to daytime fatigue in adults at rates of over 80%. However, in children, these same conditions lead to behavioral problems (45%), ADHD-like symptoms (50%) and mild learning difficulties (35%). In fact, reported daytime fatigue occurs only about 11% of the time in children.

Common Sleep Disorders in Children

There are several common sleep problems in children. These include onset and maintenance insomnia, sleep disordered breathing, movement disorders, bedwetting, and night terrors. While this list is by no means exhaustive, it does highlight the common problems parents report to pediatricians and health care professionals.

Childhood Insomnia

Insomnia is generally characterized as primary (in isolation) or secondary (due to another medical or mental health condition) and as onset (inability to get to sleep) or maintenance (inability to stay asleep). My general belief is that children can fall asleep anywhere and anytime the need strikes. So, when families are reporting insomnia, my first concern is to rule out any systemic problems in the family that may interfere with bedtime routines and sleep habits Read more

Vaccines and Autism: Science or Hoax?

Boy getting vaccineThe controversy surrounding the relationship of common childhood vaccines and autism has been raging for nearly two decades. However, the debate is comprised of about 10% science and 90% politics and media exposure. In the wake of the most recent revelation that Andrew Wakefield, MD, the original author of the 1998 article linking autism to MMR vaccinations falsified medical history on nearly all of the patients that comprised his study http://www.cnn.com/2011/HEALTH/01/05/autism.vaccines/index.html, many families are left to wonder if they can really trust any medical advice. The impact of Wakefield’s article has done egregious harm to the general health of children worldwide. While the article was ultimately retracted by the publishing journal and Wakefield himself was stripped of his medical license in May of 2010, many countries noticed a precipitous drop in childhood vaccinations in the past decade. Surges of measles outbreaks rose in the aftermath and the CDC reported that 90% of the outbreaks in th US of measles were in children not vaccinated.

In addition to the impact on general medical care for children, popular media sources were quick to raise concerns about the safety of childhood vaccines and the preservatives used in them. With the most recent revelation that the original data may have been fabricated, many parents wonder if there is any way to make a reasonable decision about vaccinations.

The Relationship Between Vaccines and Autism

There is some science that families can draw upon. Large scale epidemiology studies are available that shed light into the relationship of vaccines and autism. In my own practice, I tend to rely upon studies that track live births over long periods of time in several geographic regions. For example, the city of Yokohama, Japan decided to terminate their MMR vaccine program that ran from 1988 to 1993 and institute an alternative program. With the new system, the rates of vaccinations fell to under 2% of the population between 1993 and 1998. This rapid change provided an ideal model to study the rates of autism since essentially the MMR vaccination rate dropped to nothing. Results from the study indicated that autism rates rose dramatically during the 1993 to 1998 time frame and could obviously not be attributed to MMR vaccines (Honda, Shimizu & Rutter, 2005). Studies conducted in Denmark (Madsen et al., 2002) and the UK (Smeeth et al., 2004) also demonstrated no relationship between autism rates and MMR vaccinations. Read more

Recognizing Obsessive-Compulsive Disorder (OCD) at School: Tips for Teachers & Parents

How teachers can spot signs and symptoms of Obsessive-Compulsive Disorder in the classroom, and the important questions parents can ask them.

Girl washing hands

Obsesive-Compulsive Disorder (OCD) is a very challenging disorder that can leave both children and their parents feeling confused, hopeless or out of control. Sometimes symptoms do not show up at school, as some children work very hard to keep it disguised due to fears of embarrassment. During periods of high demand and increased stress, however, it will become especially hard for those children to hide symptoms.

Some symptoms of OCD are very obvious and well-known, while others are not observable at all. Some are observed and are considered misbehavior. It can look like “acting out,” particularly when a symptom causes so much frustration that the child breaks rules in order to do what they feel they need to do.

OCD Behaviors To Watch Out For:

• Obsession with certain numbers, including counting, touching, saying or performing any ritual a certain number of times. This includes believing certain numbers are “magical” and avoiding certain numbers, objects, or places that are considered “unsafe”, “unlucky” or “bad” (e.g. ripping or scratching out certain pages/number items from homework and test papers).

• Rituals related to the use of desks, chairs, pages in books, lockers, supplies, etc. This includes avoiding or excessively checking any objects before using them.

• Visiting the bathroom too frequently (may involve performance of rituals related to hand washing or body waste). Also look for raw, chapped hands from constant washing. Read more

What is DEVELOPMENTAL DYSLEXIA?

DyslexiaDyslexia is one of the more common conditions to affect school age children. It is estimated that between 5 and 10% of children between the ages of 5 and 20 meet criteria for the disorder. The definition of dyslexia is an inability to read; however, while this is a disorder that is very easy to define, it can be difficult to diagnose and treat. Reading is an intimate and essential skill in our school systems. Children are taught to read in first and second grade; but by grade three they are expected to acquire new information from what they read and children who have difficulties in reading will begin to suffer in all subjects if left untreated.

Dyslexia and The Brain

There has been a wealth of information published on this disorder since first conceptualized nearly a hundred years ago. What researchers have essentially concluded is that we don’t have a formal reading center in our brain. Rather, we utilize language and speech areas to make sense of written words. Thus, any disorder that affects language systems can impact reading. In fact, in adult stroke patients, there is an unusual condition called alexia (can’t read) without agraphia (can’t write), which means that a person could write a sentence but be unable to read what they had just written. Through the advent of neuroimaging, we have been able to trace the pathways that lead from the visual perception of written text to the decoding of that text for meaning and have a pretty good understanding of how children with dyslexia read (or don’t read) differently than normal children. We have not been as successful in figuring out the cause of this disorder.

The current thinking is that our visual system is built to recognize objects from a variety of different angles because we are creatures that move in the world. For instance, if I turn a chair on its side, it won’t take you longer to figure out it is still a chair. However, letters and words need to be identified in the same orientation and in the same order if they are to have meaning. The visual system, therefore, “cheats” by funneling letters and words over to the language centers for processing instead of in typical object recognition centers. If this process occurs correctly, most children will be able to read as early as five years of age. If they don’t funnel this information correctly to the left side, they will continue to treat letters and words just like objects in the environment. For instance, a child might see the word “choir” but say the word “chair” since they are visually so similar in appearance. However, their meaning is quite different and clearly comprehension is going to be affected if many of those errors occur.

Signs of Dyslexia in Children

Some of the common signs of dyslexia in younger children can be the omission of connecting words (i.e., in, an, the, to, etc.), taking the first letter or two of the word and guessing, or converting words that they have never seen into words that they already know, even when the meaning is quite different. I hear often that parents become worried because their child reverses letters and, while this does occur in children with dyslexia, it is also a fairly common phenomenon with children who are learning to read, particularly with letters that look similar (i.e., b and d). Thus, it often does take a trained professional to differentiate children who are poor readers or who are developing slowly or in a patch-like fashion from children who actually have dyslexia.

Dyslexia in School

One of the challenges with this condition is that many of the schools have gone to an RTI Model (Response To Intervention) for reading. This means that they wait to see how a child responds to a normal classroom and if they fail, they move them to additional services, and if that fails, they move them to further intense services. Failing that, an evaluation is ordered. In real life, this means that many children are not evaluated properly for several years and by that time there are major gaps in their learning and acquisition. We do know of several methods for remediating dyslexia, although they often involve multiple hours a week of tutoring on a one-on-one basis and some school systems are simply ill-equipped to provide those types of services for children.

Most children that we see here at the clinic with dyslexia are bright and capable children who become increasingly frustrated with school because they are unable to bring their intellect to bear on many of the activities they are asked to perform in the school system. Even subjects in which they find much enjoyment are limited in terms of their ability to access the material because so much of it is done through written form. They often look poor on standardized reading and math testing; but because they are bright they can usually “muddle along” just enough to escape attention until they have fallen several years behind by middle school.

Treatment for Dyslexia

Fortunately, several treatment methods have been developed over the years that lead to a “normalization” of the reading system within the brain on imaging studies and to a dramatic increase in reading scores on educational tests. Only a trained professional can determine if your child has a developmental delay, dyslexia, or some other condition that is impacting their reading; but these are often critical evaluations to get done early since the remediation process can take 12 to 24 months.

I have evaluated hundreds of children for this condition and seen rather dramatic improvements when these children are placed in evidence-based programs for even a short amount of time. I urge all families who have children who struggle with reading to at least get a consultation with a trained professional to determine an accurate diagnosis and appropriate treatment planning.