Tuesday, March 20, 2007

Well, yesterday Bob and I had the long awaited meeting with the psychologist who administered all those tests to Sam a few weeks ago. And interestingly, as we left Bob and I both felt that on the one hand, he didn't tell us a single thing we didn't already know. And on the other hand, he somehow reframed it into a perspective that helps make sense of it.

He said that while Sam's intellect is very high, as we have always known, the area psychologists call "executive function" is much lower. His executive function is not actually low, but relative to his intelligence, it is. The doctor said that only about 10% of very bright kids would have scores as low as Sam on executive function.

Executive function is controlled by the frontal lobe and governs things like working memory -- the ability to hold a set of directions in your mind while working on a project, for example. It covers a lot of self-regulation, the postponing of gratification in pursuit of a long-term goal, time management, planning, etc. Now, these are all areas where we knew he had problems. What we didn't realize was that they are all connected, all controlled by that one area of the brain.

So again, in terms of the labeling that schools and psychologists seem to love, Sam doesn't quite fit the label. Just as we know he has "Asperger's-like" behaviors but doesn't really meet the definition for Asperger's, similarly, he has ADD-like behaviors but doesn't meet the definition for ADD. Which is just as well, especially since we have previously tried ADD meds on him and they produce strong and unacceptable side-effects. (They make him anti-social.)

So the recommended course of action is that we must provide him with external structures that take the place of that internal regulation. For example, when he goes to do a homework assignment, we will now have him show or explain to us exactly what the assignment is before he starts. That will establish whether he knows or not. If the assignment is complex, and it took a lot of coaxing and guidance to get it all laid out, we might write it down, so he has those written instructions in front of him as he works. Then as soon as that assignment is finished, we will review it to see if he completed all the steps.

The psychologist will meet with Sam next week, and with his team of teachers in about three weeks, so that we are all on the same page. I had mentioned to the psychologist how frustrated we and the teachers have been by his apparent loss of motivation this school year, and the doctor was pretty sympathetic to Sam about that. He likened him to a dog that has jumped at an electric fence and been zapped enough times that now, when he looks at the fence, he just sees the pain. Even if someone opens a gate in the fence, he is likely not to notice it. In Sam's case, he started the year trying really hard to do a good job, but in spite of what really were his best efforts he couldn't stay caught up and was perpetually in trouble. So somewhere along the line, he checked out. Why invest all that energy just to fail anyway?

The doctor said in kids like this is it usually particularly hurtful and frustrating to hear, "You're not working up to your potential." Because while they have this great intellectual potential, the frontal lobe issues are just as real, so they have been working to the best of their ability -- their overall ability. But if we can get Sam to buy into building up structures to support him, then he can get past that roadblock and allow his intellect to shine. At least I hope so!

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