ADHD with superior working memory and average processing speed?
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Anonymous
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My sister has asked me for help understanding her son's neuropsych since I have gone through this all with a couple of my kids. I am writing down my questions for her to look at and, if she feels appropriate, ask during the parent meeting. At this point, they have the report and have shared it with me. Child is in ninth grade at a competitive private.
By parent report, teachers' (to a lesser extent), and child's, there are a lot of behaviors consistent with ADHD: impulsivity, issues with time management, disorganization. He has received the diagnosis and sister was told verbally that it is "classic" and "severe." I am struggling a bit because, though I have read countless books and articles on ADHD, it was probably through the lens of my own kids' profiles and test results. I thought with ADHD one would always see, for example, a deficit in working memory or processing speed--one or the other if not both. My nephew has a high average processing speed and a working memory in the superior range on the WISC, with all the academic indices in the very high average to superior range. On a different test that focused exclusively on working memory, there was more variability in subtests but overall results still quite high. On a test that focused on executive functions, he again scored well above average. There is no denying that in real life he DOES have issues with executive functions but ... isn't it odd that the tests don't really show that??? Or am I too focused on my own expectation of what I think ADHD looks like? Also, the provider makes a big issue of the variability within a section of a test. Like if the score of the overall subtest was 88th percentile with most parts scoring right around that but there was one section that was 35th or there was one question that was a below grade level mistake, she really highlights it. Is it really so unusual to have some variability?? Again, maybe I have blinders on because my kids were ALL OVER the place, from 7th percentile in processing speed to 99th in fluid reasoning (and sections of subtests... I mean we had a couple that were under 1st percentile). Isn't some variability typical?? I worry that she is searching for justifications of the diagnosis. Don't get me wrong: I am thrilled that my nephew will get therapy and support for his executive function issues, and assume a stimulant will probably help. I have been hoping for testing for a long timer and have been really worried about him. But I wonder if the testing is overlooking something, for example an anxiety component? He also has a diagnosis of generalized anxiety but there is no recommendation of therapy for that part of it or suspicion that that in itself might cause some of the issues. The report also adds a diagnosis of ASD, which I admit caught me off guard. I just don't see it. And we do have other kids in the extended family who are on the spectrum. And I am wondering where she draws the conclusion other than from the child saying he doesn't have a lot of friends. No ADOS or ADI-R were administered. Does anyone have any insights??? I am fully prepared to be told that I am off the mark. Just trying to learn! |
Anonymous
| My DH is like that. His memory is exceptional, high processing speed, very intelligent. The rest is classic adhd. |
Anonymous
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My ds got the same dx. He has no issues with processing or working memory. And got a surprise bonus asd dx. Then no one since has been able to ‘see ‘ the asd, us included (I keep trying and figure I just don’t know what asd is)
I think there is a type of adhd that is primarily behavioral. Russell Berkley considers it the ‘main’ type of adhd (a disorder of emotional regulation) but bc the dsm doesn’t actually consider emotional regulation to be diagnostic of adhd, if you have a kid with adhd whose primary challenge is true deficits in emotional regulation, you will often get an asd dx. With those kids it’s hard to see it because they socialize and interact in many ways typically - they just can’t really control their responses properly so it sort of looks like parts of asd in some ways. Adhd dude talks about this also - as does our psychiatrist. Is it accurate to consider it asd? Maybe - it just doesn’t fit with ‘classic’ asd and the marketing of ‘new add’ had been a bit sub par so it leaves parents super confused. More likely there is a ‘third’ thing that is a subtype of one or the other that hasn’t yet been named. |
Anonymous
| *new asd |
Anonymous
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People say the ados is gold standard but only in so much as the practitioner is gold standard.
Where did the evaluation take place? In a lot of the second tier places or in smaller cities they will kind of just find everything and assume you want the services |
Anonymous
Interesting, thank you. And when you say memory is excellent, do you mean working memory? As in he tested high on working memory? I am not surprised someone with ADHD can store a high amount of information, especially in their areas of interests. I have seen the hyper focus at work and get that! I am more surprised that someone would get the diagnosis with an exceptional working memory because that seems like such a classic area of impairment. |
Anonymous
Than you for sharing. Just to clarify, are you saying that Russell Barkley would likely define all of this under ADHD but that the DSM doesn't define the emotional part as ADHD so an ASD diagnosis is added to account for that side of things? That could definitely explain the diagnosis. I guess I am surprised because, don't we all know that emotional regulation IS part of ADHD and executive functions? Also, wouldn't ADHD and anxiety account for a lot of the same behaviors? |
Anonymous
Not pp but I have adhd and my working memory SUCKS but I am very competitive and have hyperfocus for any sort of test or game. IRL I can't remember more than one or two ideas unless I write them down but I ace tests of working memory. I've begun to realize that's because I can recruit other forms on encoding in a pinch-- like a synesthesia-- but it's patchwork and not sustainable over the long haul. I also tested with excellent working memory and high IQ as a child (151). My semantic memory is off the charts. But my working memory is for entertainment purposes only. |
Anonymous
| Other forms OF encoding-- and there are a couple of punctuation and word choice issues too-- forgive me, it's almost 3 am! |
Anonymous
West Coast city. This is the impression I got when reading the report. Like the report makes a big deal of a subsection that show a deficit in working memory and glosses over the fact that the overall score is in 95th percentile. Or mentions a moment of not making eye contact, even though truly eye contact is a non issue. I wondered if the their assumption is that the more diagnoses the more services? I am such a big believer in the importance of understanding a child as much as possible--both for empathy/compassion for child's experience and to be able to provide targeted help--that this seems counterproductive. |
Anonymous
OP here, hmm that is amazing, I wonder if something like that is going on. Child is definitely very competitive and bright and surely wanted to perform well for tester. And as a side note, I think I may be a lesser version of this, too. I have never been tested for ADHD so I am not sure but I was an excellent student all the way through several higher degrees but have realized as an adult that my executive functions are terrible. Much, much better at school than regular life. |
Anonymous
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Neither of those measures has to be below average to support an ADHD diagnosis, the key is that there is a significant disparity between the measures. An average processing speed can be very limiting to someone who scores in the superior range for other measures of intelligence, and will inhibit their ability to reach their full intellectual potential. The frustration from that limiting processing speed can lead to lots of ADHD behaviors like impulsivity, struggles with time management and disorganization.
Variability in test results can also suggests ADHD if it reflects an inability to sustain attention once the test is no longer engaging or rushing through sections because the processing speed limitation (again, as compared to other components of intelligence) is frustrating him. |
Anonymous
Thank you. I didn't know what you say above. I know in my own two with ADHD who score in superior range in other measures of intelligence, their average working memory is addressed as a source of frustration but I assumed that their single digit percentile processing speed was a more key part to the diagnosis. Another interesting part of my nephew's testing is that he actually made zero mistakes in the processing speed section of the WISC. It seems that he slowed down to ensure he got everything correct--which if the end result is average, seems like a decent compensating strategy. Regarding variability: I'd really like to read more about what is an expected amount of variability. I have read studies about what is expected among sub-sections of the WISC, for example, vs what is clinically significant, but not WITHIN a subsection. Do you have any suggestions?? Thank you! |
Anonymous
That’s only a decent compensating when you have the luxury of unlimited time to complete a task. In reality, people rarely have that, either because the task itself is time limited or because other responsibilities mean you can only give so much time to a given task. |
Anonymous
I’m not exactly saying the asd dx is there to explain ‘non dam’ adhd. I think what I’m saying is what Russell Berkley sees (and many of us see) as the defining characteristic of adhd is not even in the dsm. Adhd is poorly understood and poorly characterized (as is asd) so often kids will get both dx to explain the ‘slightly inexplicable’ Put it this way - if there was another separate dx - let’s call it ‘pikachu’ - where the constituent pieces were lack of emotional regulation, impulse control, inflexibility, difficulty with transitions, irritability and ability to hyperfocus (I’m just guessing, you haven’t said this but this is description of the type of adhd that usually comes without attention deficits and rides with asd) would you question that he has it? |