Going Beyond The Testing Norm: The Importance of a Comprehensive Approach to Testing Twice Exceptional Students

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Author: Elizabeth Bodnar, Ph.D.

Twice Exceptional (2e) students have unique and complex neurocognitive profiles and associated learning needs that often go unidentified and unsupported. The lack of access to comprehensive assessment is one piece of this problem. Testing of 2e students needs to include more than just IQ and academic achievement. Using a comprehensive approach to testing allows the student’s family and educational team to understand and support a whole person rather than a statistical discrepancy between ability and performance.

2e students are usually defined as individuals with superior abilities on tests of general reasoning and problem solving skills and an identified neurodevelopmental disorder, such as attention deficit hyperactivity disorder (ADHD) and/or specific learning disabilities in reading, writing, and/or math. Many educators and psychologists who work with 2e students find that they are under-identified and under-supported in both public and private academic settings because they are thought of as falling into one of the following categories:

  1. Bright but no drive: The student is identified as intellectually gifted but felt to be an academic underachiever. Often these students are described in ways that suggest they “should” be capable of better academic functioning. For example, the student may be called “lazy” or “unmotivated”.
  2. Learning disabled: The student is identified as having a disability (of learning and/or attention), but strong intellectual abilities have not been identified. As such, instruction tends to focus on weaknesses while never building on strengths.
  3. Average: The student is not identified as having either a gift or a disability. These students appear average because the superior intellectual skills mask the disability, but the disability pulls academic performance down from the student’s true potential.

The under-identification of 2e students occurs, at least in part, because of a lack of effective testing for proper identification and support. Testing only IQ and academics may indicate the presence of superior skills in conjunction with learning disabilities, but it will not reveal the executive dysfunction underlying reports of laziness, or the depression and low self-worth arising from a focus on academic weaknesses alone, or the low frustration tolerance and anxiety associated with being challenged but not supported.

Typical psychological assessment completed through the public school system includes testing of cognitive function, academic abilities, and parent and teacher report of behavior/emotional function. School psychologists are often stretched thin and may not be provided with the time or proper tools for a more comprehensive evaluation. In general schools will not test students with average grades, so children with higher than average potential but average performance do not qualify for school-based testing. Psychologists in private practice usually have the time and resources to administer more tests, including objective measures of attention and evaluation of memory skills. However, private testing tends to be expensive and most insurances will not cover evaluation of any need felt to be educational in nature. Because of this, parents often seek more targeted evaluations from private psychologists for financial reasons. In addition, not all private psychologists have been trained to select the most effective and efficient battery of tests to assess a 2e student.

It is the role of comprehensive assessment to help educators, parents, and students themselves uncover the complexities of a 2e learners so that the team can create the right educational program. Comprehensive testing is not administering every test available to a given clinician. Rather, comprehensive testing should mean careful selection of a variety of assessment tools for an efficient but informative and holistic picture of a child at a given point in time. Depending on the age of the student, the evaluation should include information about the following areas of function:

  • General reasoning and problem solving skills (IQ)
  • Processing Speed
  • Attention, which can be subdivided into areas such as attention span, sustained attention, and divided attention
  • Language
  • Visual Perception
  • Visuomotor and/or Sensorimotor
  • Learning
  • Memory
  • Executive Function
  • Academic Achievement
  • Adaptive Skill Development
  • Emotional and Behavioral Functioning (including social abilities)

It is particularly important for those evaluating 2e students to look closely at the following domains:

Processing Speed: Many 2e learners need more time to take in information and generate a response. This can be especially pronounced when the response format includes a motoric output, such as writing.

Learning and Memory: Not only is it important to capture learning and memory ability in visual and language domains, but it is equally important to document the impact of executive function on a child’s approach to these tasks. For example, the clinician should look closely at task planning, initiation, strategy use, consistency of performance across trials, organization of information, and self-monitoring. Often, poor approach and organization during learning and memory tasks affects a student’s ability to encode and recall information in a way that makes sense.

General Executive Function:  Executive functions (EF) include, but are not limited to, planning, initiation (getting started), working memory, organization, flexible thinking, decision-making (simple problem solving), and behavior regulation that are necessary for guiding goal-directed behavior. EF in 2e students should be examined both within the assessment setting using performance-based measures and in the everyday setting via parent and teacher report. Sometimes bright children perform well on tasks of EF in the testing environment but struggle with daily EF demands. However, careful performance-based assessment that includes clinical observation in conjunction with overall task performance can often identify subtle markers of weakness.

Writing: Of all the academic tasks, writing is the most integrative and requires the most EF. When writing, a student must pull together speed, focus, motor skills, content information, working memory, planning, organization, and monitoring skills to be successful. Unfortunately, performance-based measures of writing available to psychologists are lacking in rigor and no longer match academic curriculums, especially the expectations associated with Common Core. It is often best to use comprehensive testing to measure all the underlying skills needed to write well and provide recommendations to support specific areas of weakness as they may impact the writing process.

Behavioral Regulation: 2e students are more likely to struggle with behavioral regulation in the context of frustration and changes to their environments as compared to other students. 2e learners who are challenged without disability support are often easily frustrated by tasks they perceive as too difficult. Many intellectually gifted children define intelligence as “easy or effortless” completion of academic tasks. When something does not feel easy immediately, it makes them question their intelligence, resulting in the need to escape from the task. In addition, EF difficulties often impact the process of task completion, so frustration can arise because the student knows the answer but can’t meet expectations around following a specific process or showing work. Measuring EF skills, thorough clinical interview around behavior, and report measures for parents, teachers, and potentially the student, should be used to identify behavioral needs.

Emotional Function: Gifted children are frequently intense people. They tend to have strong emotional reactions to frustration, but are also more prone to anxiety and depression symptoms. It is common to see these symptoms arise when a student is challenged but not supported or not challenged at all. 2e students are often quite aware of the discrepancy between the complexity of their thinking and their work output, leading to a lack of self-esteem and self-efficacy in academic settings. 2e learners frequently come to believe they are “stupid”. The combination of performance anxiety, low self-esteem, and depression can further impact EF, resulting in a vicious cycle. While 2e students are intellectually advanced, their emotional and behavioral functioning may be age appropriate or immature due to their disability, which can be difficult for parents and educators to manage. Because of these factors, it is essential that emotional function be assessed.

Social Function: Many 2e student have trouble finding their social stride. They may struggle to find other children with whom to connect and may have social skill deficits that make them targets for bullying. A lack of social stability further impacts behavioral and emotional function with cascading impacts on EF and willingness to engage at school.

Using comprehensive assessment to paint a detailed picture of a 2e student’s strengths and needs helps educators and parents to better understand and support 2e learners holistically across settings. When we take testing beyond the norm, we are better equipped to help our 2e students go beyond the norm in their development.

That being said, general education settings are still working to find ways to meet these students’ needs. There continues to be a lack of understanding of the 2e student in many academic environments and it is not uncommon for these students to be excluded from accelerated tracks because of skill deficits directly related to their disability. More consistent use of comprehensive assessment to identify these students and their needs will help guide academic settings toward more specialized educational programming for 2e learners. This movement is already occurring in some public school settings, such Montgomery County in Maryland where there are now Gifted & Talented/Learning Disabled (GT/LD) programs.

When looking for a clinician to perform comprehensive testing, parents should feel empowered to ask questions about the practitioner’s experience evaluating 2e students, the approach to testing, and what areas of function will be evaluated. It is important to feel comfortable with the clinician prior to beginning the process and as the assessment process unfolds. Often a child’s pediatrician will be able to recommend a psychologist to assist in the process.

Resources

Montgomery County GT/LD Program http://www.montgomeryschoolsmd.org/curriculum/enriched/gtld/

“Emotional Intensity in Gifted Children: Helping Kids Cope with Explosive Feelings” by Christine Fonesca

“Bright Not Broken: Gifted Kids, ADHD, and Autism” by Dianne Kennedy and Rebecca Banks

“Different Minds: Gifted Children with AD/HD, Asperger Sydrome, and Other Learning Deficits” by Deidre Lovecky

“Twice Exceptional Gifted Children: Understanding, Teaching, and Counseling Gifted Students” by Beverly Trail

“If This is a Gift, Can I Send it Back? Surviving in the Land of Gifted and Twice Exceptional” by Jen Merrill and Sarah Wilson

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About Author

Dr. Elizabeth (Beth) Bodnar is a Clinical Psychologist specializing in the assessment and treatment of children with a wide range of neurodevelopmental concerns including ADHD, anxiety, OCD, depression, and learning disabilities. She previously worked at the Kennedy Krieger Institute, Department of Neuropsychology and is now in private practice in Towson, Maryland. Beth lives in the Towson area with her husband, two children, and a bossy cat. She can be reached at drbethbodnar@gmail.com or through her website www.drbethbodnar.com

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