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Possibly Twice Exceptional with ODD (Oppositional Defiant Disorder)

By Inderbir Kaur Sandhu, Ph.D

Q: We are a family living in Norway. We have a 9 years old son. He has been enrolled in the special health service (psychiatric out-patient clinic) for several years, due to behavioral problems and has been diagnosed with ODD. He was tested with WPPSI III, just before he turned 6 years and got a verbal IQ score of 102 and a performance IQ of 133. Processing speed was in average level. We do not know the sub score. He was tested again at 8 years, with WISC-IV. He did well in the part of matrix reasoning and blocks design. The score in these parts were 14 and 15 respectively. On picture concept, he scored 10. Due to this result, they could not calculate a PRI. The rest of the test, he scored on average. None of the part scores were below average, but it was noted that he also scored very high on memorizing backwards; as a 17 year old. On memorizing forward, the score was normal. We are wondering how to interpret the big difference in test score, especially in the first test?

He is strong in mathematics, particularly mental calculation. He has a good logical sense and is very creative and a good problem solver. He loves construction building and does it very well. He is skilled at puzzle and managed 100 pieces at the age of 26 months. He is good at drawing. He likes foreign language and has a very good lingual understanding. He does it well in spelling. He is a good reader and has a normal language, but he's struggling to express his inner thoughts, as well as explaining his reasoning to arrive at an answer. When he wants to explain something, he is struggling to get to the point. He often has difficulty getting his thoughts down on a piece of paper. He struggles to put tasks into system. His work is often disorganized and it can be hard to understand what his intentions are. He has a pretty handwriting and has no problems with fine motor skills. He has difficulty following verbal and written instructions, but understands the content of what he reads and hears. He often doesn't “receive” instructions which are given in a plenary situation, typically when his teacher addresses the whole class. In this situation, he often has to look at what all the others are doing, in order to understand what he is supposed to do. Also he doesn't seem to understand the link between effort and success. If he doesn't manage something straight away, he doesn't put any effort into learning things.

He is very sensitive to what he experiences as criticism and is very vulnerable. He is a perfectionist. He is impulsive, headstrong, opinionated demeanor, has frequent mood swings, he gets easily frustrated. He has a lot of empathy, but has trouble controlling himself. When he is emotionally distressed, he can be aggressive. In some occasions, he has been physical with other children. For the most part, he has an ok relationship with friends, but because of his unpredictable mood, and at times aggressive behavior, he has a bad reputation. He has a strong need to be seen and recognized, as he has low self-esteem and does not like to get praised. He blames others for his mistakes.

As we see it, he has both strong and weak verbal skills. We're wondering if the verbal score in ability tests really shows the full picture? Could there be some kind of under laying expressive language disorder? Having searched the internet for clues, we think many of his personality traits fit well with the diagnosis twice exceptional. The term twice exceptional has generally little acceptance here in Norway and the special health service here has very little knowledge about it. Until now, their focus has mainly been to address the social issues and he has been given very little facilitated teaching at school. We would be thankful if you could give us some more insight into who he is and what his needs are? Our biggest wish is to get him the right help.

A: Briefly, ODD (Oppositional Defiant Disorder) is a condition in which a child displays an on-going pattern of uncooperative, defiant, hostile, and annoying behaviour toward people in authority (e.g., parents, teachers). The child's behaviour often disrupts the child's normal daily activities, including activities within the family and at school.

It should be noted that a good number of children and teens with ODD also have other behavioural problems, such as attention-deficit/hyperactivity disorder, learning disabilities, mood disorders (such as depression), and anxiety disorders. Some children with ODD go on to develop a more serious behaviour disorder called conduct disorder.

I am not sure what kind of treatment your son is getting after the diagnosis - has his condition improved over the years with constant intervention? Psychotherapy can be very helpful but needs to be regularly done and involving parents. Is there any other concern that was detected during the evaluation? Due to the large discrepancy of the scores, it is likely that he may have a learning disorder as well which could be affecting his learning further. Another possibility is APD (Auditory Processing Disorder), which can present itself with many different symptoms and behaviours. Quite often, these behaviours may resemble those seen with other learning challenges, like language difficulties, attention problems and autism. You may want to check on this as well.

Whether your child may be twice exceptional is hard to tell until further testing and observation is done. The intensity, sensitivity, and idealism of gifted children often lead others to view them as “strong-willed.” Power struggles with parents and teachers are common, particularly when these children receive criticism, as they often do, for some of the very characteristics that make them gifted. IQ tests are a good point to start with but detail breakdown of scores is required to determine the possibility of a learning disability. You may need to seek help from a reputed psychologist who is able to interpret the scores.

Research indicates that it may not be possible to prevent ODD, but by recognizing and acting on symptoms when they first appear, it can actually minimize distress to the child and family. In addition this could prevent many of the problems associated with the disorder. As a family, you need to learn steps to take if there are signs of relapse. Of course above all, providing a nurturing, supportive, and consistent home environment with a balance of love and discipline is likely to help reduce symptoms and prevent episodes of defiant behaviour.

It is not possible to tell from a couple of test alone. Further testing is required to determine his verbal and performance ability. The WISC-IV scores are not interpretable - further testing should have been recommended to gauge his performance. I would recommend a through educational evaluation - only a proper diagnosis of all his learning concerns and strength would enable suitable intervention that would help him in his learning. All the best.


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