Paul Beljan Psy D ABPd N ABN 9835

Paul Beljan, Psy. D, ABPd. N, ABN 9835 E. Bell Rd. , Ste. 140 Scottsdale, AZ 85260 (602) 957 -7600 www. beljanpsych. com p. beljan@beljanpsych. com Twitter@Beljan. Psych http: //motorcognition 2. com/ 6/7/2021 Paul Beljan (602) 957 -7600

6/7/2021 Paul Beljan (602) 957 -7600

• • Bell Curve and IQ Characteristics of Gifted Common Disorders Common Misdiagnoses Discrepancy Model and Learning Disability Easy Rule Outs What to do? 6/7/2021 Paul Beljan (602) 957 -7600

Distribution of Intelligence Quotients 6/7/2021 Beljan Psychological Services (602) 957 -7600

CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSES • Asynchronous Development • Impatient with other people during periods of intense focus • Neglects duties in favor of reading or interests • Advanced and diverse interests (jumps from one to the next) • Narrow interests (could be a lifetime focus ex. Light=Einstein) • Reluctant to move to new activities-transitions • Makes jokes or puns at inappropriate times 6/7/2021 Beljan Psychological Services (602) 957 -7600

CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSES • Judgment/awareness lags behind intellect/insight • Poor handwriting • Lacks interest in details (ex. does math in mind) • Turns in messy work (works too fast) • Unusual sleep patterns • Peer relation problems, unless with like intellectual peers 6/7/2021 Beljan Psychological Services (602) 957 -7600

CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSES • Emotional sensitivity and intensity (“over-excitabilities”) • Strong-willed; power struggles • Boredom if educationally misplaced • Resists routine/repetitive practice • Creative, non-traditional thinking style • Feeling on equal footing with adults 6/7/2021 Beljan Psychological Services (602) 957 -7600

CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSES • Challenging; non-conformist; disrupts status quo • Refuses to accept authority; stubborn • Idealism/fairness • Impatient with failures/disappointment • Self-critical; perfectionism; unwillingness to take risks • Oversensitivity to criticism; may overreact • Easily becomes angry or cries when things go wrong 6/7/2021 Beljan Psychological Services (602) 957 -7600

FREQUENT MISDIAGNOSES OF GIFTED CHILDREN • • Attention Deficit/Hyperactivity Disorder (ADHD) Oppositional Defiant Disorder (ODD)/Conduct Disorder • Bi-polar Disorder • Dysthymic Disorder • Narcissistic Personality Disorder • Learning Disabilities (LD) • Avoidant Personality Disorder • Obsessive-Compulsive Disorder (OCD) • Intermittent Explosive Disorder • Autism Spectrum Disorder (ASD) • Schizoid Personality Disorder • Major Depressive Disorder (MDD) 6/7/2021 Beljan Psychological Services (602) 957 -7600

DISORDERS THAT COMMONLY INVOLVE GIFTEDNESS (2 e) • Learning Disabilities (LD) • Obsessive-Compulsive Disorder • Exec Function Based LD (PAC) • Parent-Child Relationship Problems • • Attention Deficit/Hyperactivity Disorder (ADHD) • Relational Problems with peers • Asperger’s Disorder (AD) • Depression (existential) • Allergies (particularly food) • • Reactive Hypoglycemia Sleep Issues – nightmare – sleep terror – sleepwalking 6/7/2021 Beljan Psychological Services (602) 957 -7600

Diagnosing 101: Rule out the easy stuff • • • 6/7/2021 Short Term Memory Processing Speed Auditory Processing Sensory Integration Oppositional Defiant Spectrum Disorder (Conspiracy) Paul Beljan (602) 957 -7600

Base Rates • Clustering symptoms and factoring them against the age, gender, weight, SES, culture, etc. , of the patient to quickly reduce many possible diagnoses down to a few likely diagnoses. 6/7/2021 Paul Beljan (602) 957 -7600

Short Term Memory • First, consider how significantly impaired a child would be if he/she had a short term memory deficit. • Learning would be completely impaired. • If a child never suffered had an inutero or birth injury, became asphyxiated, experienced a severe blow to the head, or had any other seizure or disease process involving the brain; then what would be the likelihood of them having a short term memory deficit? • The answer is nearly zero. 6/7/2021 Paul Beljan (602) 957 -7600

Short Term Memory • If children perform well on only one encoding task, they do not have a short term memory deficit; because how could a child do well on any task of encoding if they have a short term memory deficit? They could not. • You cannot fake a skill if you do not have it. • When this is determined, then I begin to look at what causes a child to seem like they have a short term memory deficit when in fact they do not. 6/7/2021 Paul Beljan (602) 957 -7600

Short Term Memory • One must pay attention to information meant for encoding in order for that information to be encoded into short term memory. – Gifted children are often bored in class or taken with their own entertaining thoughts. – If information is not encoded then the result is a child who seems to have a short term memory problem, when the child actually was not listening or was distracted. Problem solved. 6/7/2021 Paul Beljan (602) 957 -7600

Processing Speed David Letterman “Top 10 List” “How do you know you have a dumb dog? There is a long delay between Bow and Wow. ” 6/7/2021 Paul Beljan (602) 957 -7600

Processing Speed • Three tests on the Wechsler Intelligence Scale for Children- fourth edition (WISC IV) can rule out a speed deficit. • Symbol Search • Coding • Block Design 6/7/2021 Paul Beljan (602) 957 -7600

Processing Speed • Compare the WISC IV SS and Cd tests to the BD test. • Double checking work on SS and Cd causes the child to earn correct responses, but less of them, ultimately rendering a lower score. • Gifted children frequently yield fast BD times (under 10 seconds) on the 45 second items and earn bonus points for fast completion on the more difficult 120 second items. – Low scores on SS or Cd and high scores on BD rules out a cognitive speed deficit, and vice-versa. – **recent TBI dx based on misinterpretation of SS and CD in forensic case 6/7/2021 Paul Beljan (602) 957 -7600

Auditory Processing • APD is commonly questioned by parents of gifted children. • APD has numerous definitions. • Most consistently it means the physical elements of the outer and inner ear function, but the child has difficulty processing and making sense of how language sounds in their head. – This seems more like a receptive language disorder than an audition issue. Could Be: Engrossed in their thoughts/activity = not listening 6/7/2021 Paul Beljan (602) 957 -7600

Auditory Processing • True APD is rare and impairing. • I only see it co-morbidly with phonological processing deficit. • Get an audiology evaluation in addition to neuro/speechlanguage evaluation. – The child tries to identify a given sound while a competing sound is presented. – In my experience, children with attention deficit have the same problem, but no one claims it is an APD. – Attention deficit is a disorder of sustaining and prioritizing attention. 6/7/2021 Paul Beljan (602) 957 -7600

Sensory Integration • Sensory Integration Disorder (SID): • Think Asynchronous Development – SID basically means the child’s sensory system is working well, but their frontal lobe (i. e. , cerebellar-thalamocortical-basal ganglialneostriatal-frontal circuitry) mediation of the sensory stimulus has not developed to the extent that it can be put in the background of experience. – In other words, the child cannot yet inhibit/modulate sensory experience; it does not mean the sensory system is impaired (Koziol 2010 & 2011). 6/7/2021 Paul Beljan (602) 957 -7600

Sensory Integration • Why does treatment help? – The sensory system is working well. – Tx feels really good and the response is temporary • Tx is external soothing – The px comes back fast • The px resolves with time and higher cortical development (i. e. , inhibitory control) • Bonus caveat: Ever meet an adult with SI? 6/7/2021 Paul Beljan (602) 957 -7600

Oppositional Defiant Disorder • ODD is made, not born. • Parent/Parents/Caretaker; home; food; warm bed; hugs and told, “I love you. ” • Does the dx exist across environments? – School only? Home only? Socially only? 6/7/2021 Paul Beljan (602) 957 -7600

Oppositional Defiant Disorder • Is the child overly indulged for intellect? – Negotiating? Arguing? Tantruming? Defying? – “Why” before compliance? • Has the child been assisted to develop a full identity that does not stand solely on intellect? – They were born on the intellectual 3 rd base; they did not hit a triple. • Are inappropriate behaviors overlooked and justified as high intellect? • Sports figure Narcissism 6/7/2021 Paul Beljan (602) 957 -7600

Oppositional Defiant Disorder • ADHD children who are gifted cannot reliably and consistently express working memory, inhibition, and sustained attention for as long as they want and whenever they want, and their variable expression causes a ‘Swiss cheese’ effect in academic and behavioral performance. • These children often are identified as willful or oppositional because when they are experiencing an ‘ADHD moment’ and their working memory, inhibition, and sustained attention is undermined, they cannot execute a previously expressed skills, and that looks willful. 6/7/2021 Paul Beljan (602) 957 -7600

AUTISM SPECTRUM CONSPIRACY • No insurance support before 2003 ish • Insurance has to pay for ASD tx -2004 ish – Why? • Big pharma & lobbyists – ASD tx is often drugs » Psychiatry prescribes the drugs » Psychiatry writes the DSM » The diagnostic bar is lowered FOLLOW THE MONEY 6/7/2021 Paul Beljan (602) 957 -7600

LEARNING DISABILITIES – Why discrepancy model is wrong – Reading/Spelling (Dyslexia) – Math (Dyscalculia) – Hand Writing (Dysgraphia) 6/7/2021 Paul Beljan (602) 957 -7600

The Discrepancy Model (DM) • IQ is 22 points (1. 5 standard deviations) above achievement scores • The child functions two grade levels below placement • Led to most children in USA not receiving specialized reading remediation until 3 rd grade because you cannot get two grade levels below 1 st or 2 nd grade. • Bush II era replaced PL 94 -142 with IDEA, which rang in teaching to the AIMS test 6/7/2021 Paul Beljan (602) 957 -7600

The Precursor: What Must Be Known Before Advocacy Begins 6/7/2021 Paul Beljan (602) 957 -7600

How do you know who to see? Ask yourself: What is the origin of the problem? • • • Medical Brain Based Learning Based Emotional Based Trauma Based 6/7/2021 Paul Beljan (602) 957 -7600

How do you know who to see? • Rule out everything medical first – Many medical disorders mask as psychological issues • • • 6/7/2021 Thyroid Bladder Infection Allergies/Food Sensitivities Low vitamin and amino acid levels Genetic syndromes Paul Beljan (602) 957 -7600

When the only solution in the toolbox is a hammer, then every problem looks like a nail • Psychiatry – Developmental understanding of children? • • Arranging cars Pouring water Tantrum Bx Toe walking; flapping; eye contact (shy vs gaze avoidant) • Distractibility • Hyperkinesis 6/7/2021 Paul Beljan (602) 957 -7600

How do you know who to see? • A neuropsychological Assessment accounts for everything – Development • • 6/7/2021 IQ Academic Achievement Attention/Executive Function Learning and Memory Speech/Language Sensory Motor/Visual Spatial Spectrum – one swallow does not make a summer Paul Beljan (602) 957 -7600

How do you know who to see? • Rule out everything psychological Emotional/Family/Social/Trauma – – – – 6/7/2021 Asynchronous Development Intensity Innate anxiety/depression/OCD Toxic living environment Experiencing/witnessing a traumatic event Incongruent fit between intellect and school environment Bullying Undiagnosed giftedness or learning disorder Paul Beljan (602) 957 -7600

Finding the appropriate professional • What is their training/knowledge base in gifted? • If they are neuropsych: What was their training in neuro and gifted? » APA Internship » APPIC Post-doc in neuro (at least one full year) • If they are medical: Do they acknowledge gifted? 6/7/2021 Paul Beljan (602) 957 -7600

Professional Civility • Will they give you 10 min to interview them: free? • Will they take a short phone call at times: free? • Do they bill you for a fax or a short letter? • Are they more about money than your child? • Do they call you back within 24 hours? 6/7/2021 Paul Beljan (602) 957 -7600

When Disorders are NOT Disorders: • A pediatric neuropsychologist looks at all elements of functioning as opposed to individuals who specialize in one area and tend to only look for and find issues within their wheelhouse of knowledge. It takes a whole brain to function, so the whole brain should be evaluated to rule out erroneous diagnoses. 6/7/2021 Paul Beljan (602) 957 -7600

Learning Disabilities are Brain Based Disorders • The neuropsychology of LD it too vast and complex for this discussion; suffice it to say the following: – To execute skills and tasks the brain functions in a multimodal manner that is highly interdependent upon the interactions between the micro-systems of neurochemicals and neurons to pathways, and the macro-systems of the limbic system, white matter, grey matter (higher cortical processing), and the cerebellum. – 135 iq with 100 Achievement scores = LD, but the gifted child will not receive services. 6/7/2021 Paul Beljan (602) 957 -7600

When Disorders are NOT Disorders: Katz, J. , et al. Handbook of Clinical Audiology Sixth Ed. Lippincott Williams & Wilkins, 2009. Green P. , Josey, F. The Use of an Earplug to Increase Speech Comprehension In a Subgroup of Children with Learning Disabilities: An Experimental Treatment. Applied Neuropsychology. 2002, Vol. 9, No. 1, 13– 22. Koziol LF, Budding DE, Chidekel D. Sensory Integration, Sensory Processing, and Sensory Modulation Disorders: Putative Functional Neuroanatomic Underpinnings. The Cerebellum 2011 Dec; 10(4): 770 -92. 6/7/2021 Paul Beljan (602) 957 -7600

When Disorders are NOT Disorders: Koziol LF, Budding DE, Chidekel D. Adaptation, Expertise, and Giftedness: Towards an Understanding of Cortical, Subcortical, and Cerebellar Network Contributions. The Cerebellum 2010 Dec; 9(4): 499 -529. Goldberg, E. The Executive Brain: Frontal Lobes and the Civilized Mind. Oxford Press, 2001. 6/7/2021 Paul Beljan (602) 957 -7600

Paul Beljan, Psy. D, ABPd. N, ABN 9835 E. Bell Rd. , Ste. 140 Scottsdale, AZ 85260 (602) 957 -7600 www. beljanpsych. com p. beljan@beljanpsych. com Twitter@Beljan. Psych http: //motorcognition 2. com/ 6/7/2021 Paul Beljan (602) 957 -7600