Why does my child worry so much? How comprehensive evaluations can help find the real diagnosis

This piece first appeared on Gifted Homeschooler’s Forum.

Alex was eight and in third grade when I met him. He was referred to me because of his behavior problems and was said to have “Oppositional Defiant Disorder.” He was running out of classrooms, pushing students and teachers, and refusing to do his school-work. His mother described Alex as a highly sensitive and caring child who loved to work on projects, garden, play computer games, and watch and help the workmen at the house.  She said Alex seemed to be highly emotional and reactive lately, more than usual, and could be set off at the slightest thing. Since neither his parents nor the school could figure out what was going on, we decided that a comprehensive evaluation would be helpful for putting the pieces of the puzzle together and finding some answers.

Alex did not come to my office at the expected time. I waited for a bit then decided to go out to the street to see it he and his mother happened to be waiting out front. I immediately recognized Alex, though I had never met him—he was standing on top of his mother’s car and pretending to shoot people with an invisible, make-believe gun. His mother didn’t know what to do as she had tried everything to get him down. I approached slowly as she shrugged to me in hopelessness. While this is not exactly the way one wants to meet a child on the first day of testing, I was seeing Alex in the raw—a version of what had been happening in his daily life. I calmly approached Alex and introduced myself. I took extra precaution to remain calm and non-judgmental. I told him I was looking forward to getting to know him and my job was to help him feel better. I told him he could stay up on the car as long as he wanted and I would wait here for him until he was ready. Eventually, he was ready and we walked into my office.

Alex’s eyes were intense. He was assessing me and the office surroundings. I could tell he was gauging if I could be trusted and waiting for something bad to happen. After talking for a bit, I told him about the testing process and how by doing activities together, I would learn more about him to make school better. While he did not want to talk about much, he did say he wanted school to be better. We started with some verbal subtests of the IQ test since I knew he would not be threatened by many of the simple questions and would gain confidence in himself and the testing situation. Things were going well until we came to a subtest where he needed to copy symbols from a key on the top of the page into rows of boxes. Alex froze. He looked—no, stared— at me with what seemed to be anger. He said, “I am not doing that.” I tried all my Jedi mind-tricks and nothing worked. Nothing would get him to do what I thought was a simple paper and pencil exercise. He picked up the paper and started to rip it in half—just enough to make me think he was going to go through with it. I waited, watched, and tried to think about my next move. By this time I was frustrated and wanted to keep the testing moving. In both a partial act of frustration and strategy play, I took the paper from him, ripped it in half, and said, “There, you don’t have to do it, let’s do something else.” He was shocked and his face changed from anger (and fear) to compassion and remorse. Alex picked up the two pieces and asked, “Do you have tape?” Alex taped the paper together and said, “I am ready to do it.”

Alex did the subtest, barely. He could hardly hold and maneuver a pencil. He had the most delayed visual-motor dexterity I had ever seen. Further, while Alex had advanced verbal skills, he had significant difficulty with all of the visual tasks he was given. He had trouble putting blocks together to match a picture. He had trouble picking out the missing part of designs. He didn’t seem to understand or recognize numbers and had significant math challenges. Yet, Alex had an advanced vocabulary and a very strong memory. He talked early and got along well with adults. However, Alex was very literal with his advanced words and didn’t understand puns and sarcasm. As a result, he often misunderstood what others were saying, missed social nuances, and wasn’t able to rely on reading non-verbal communication.

After a thorough evaluation of Alex’s cognitive, academic, attentional and executive-functioning abilities, mood, and behavioral profile, it became clear that Alex, although very bright and in the gifted range verbally, had what is called a Nonverbal Learning Disability (NVLD). This invisible disability caused him to misperceive, react, be confused, overwhelmed, and live with fear and anxiety on daily basis. School was his living nightmare. He had sensory sensitivities and was in a constant state of sensory overwhelm in the large 30-student classroom, did not pick up on or understand his teacher’s or other students’ non-verbal communication, and had difficulty copying, writing, and doing math. Alex, thought of as oppositional and a behavioral problem, was in a constant state of hyperarousal and fear. His anxious state was largely the result of his NVLD and its associated challenges. Nobody knew.

Understanding Alex’s complex profile was the beginning point of a long road to happiness and success. Through learning about his learning differences and how they drove his anxious behavior, which usually came in the form of refusal or aggression, his parents, extended family, and educators gained empathy for Alex. Rather than seeing him a behavior problem, they saw him as someone who acted out when he was afraid and needed support. This support included parenting strategies to reduce his anxiety by increasing communication about upcoming transitions, using verbal communication with non-verbal messages, and choosing environments that were less chaotic and more structured. It was no longer a surprise why he acted out, what his learning and processing weaknesses were, or equally important, what his superior verbal abilities were and how they could be reinforced and used to his advantage. This plan also included counseling for his anxiety, educational therapy for his learning challenges, occupational therapy for his sensory processing challenges. Alex initially benefited from a behavioral support aide and spent several years in alternative learning environments and co-ops before graduating from a main-stream high school (his ultimate goal).


If you are reading this, chances are you have a complex child. And if you have a complex gifted child, chances are he or she is intense, sensitive, anxious, and perfectionistic—at some time or another, or to some degree or another. As you well know, children, including gifted children, are all unique with differing temperaments and profiles. Your kid differs from the masses, which is why you are reading this and looking for educational alternatives and parenting guidance for your child. I know well, both personally as a father and professionally as a psychologist who specializes in gifted and 2e children, it can be very difficult to understand what is driving your child’s behavior. Why is she acting that way? Why is she fine when she is with us and shuts down every time we go somewhere new? Why does he start screaming every time we go to the store? Why is he always melting down? Why does she avoid doing anything that does not come easily to her?

These are questions parents ask us daily at our center, and questions with which my wife and I had to contend with our children. I know that most of us parents have one primary goal: for our children to be relatively happy, learn to navigate life’s challenges, and live meaningful lives. I am all for cost-effective simplicity. However, as you well know your gifted and 2e kids are anything from simple. Comprehensive evaluations of your child’s thinking, learning, emotions, and behavior can provide the roadmap for nurturing your child’s development and knowing what he or she needs to either get over a developmental hurdle or build skills that are not hardwired. Comprehensive evaluations by professionals who understand gifted and 2e kids and their complexities can explain the “why” of your child’s behaviors and give you the answers you are looking for.  Nobody knew why Alex was behaving the way he did and why he was always scared. After they found out, his life (and his parent’s lives) started to get better.

For more information about scheduling a comprehensive evaluation for your child, please visit Summit Center.