We have a 14-year-old son. I am searching for a neuropsychologist in my area that has experience with young people who may have developed compensation for various dyslexic conditions; his reading comprehension is strong and he is very articulate but he struggles mightily in math and science and simply cannot write. While he has been on an IEP for years, it’s basically useless because we don’t really know what is going on.

There is clearly a major problem with executive functioning and attention. I didn’t think of testing for any of the dyslexia-related conditions because we got so obsessed with this very ambiguous “sensory processing” disorder. One night this past school year he was so lost doing homework he simply said: “Dad, just tell me what to do.” My heart nearly broke as I choked back the tears.

I look forward to your recommendation.

Dr. Pierson's Response: 
I'm sorry that your son is struggling and, as a result, you are in trying to find him what he needs. I know how challenging that can be. Sadly, yours is not the first time I've heard that an IEP is not working.

I typically refer people to the provider list for their state from the International Dyslexia Association, and typically, neuropsychologists are not on these particular lists. You need to know that not everyone on these lists diagnoses (not sure if you are looking for a diagnosis or instead interested in knowing his pattern of strengths and weaknesses and how to help him based on those), so should you inquire. You will want to be sure to ask that question, and, importantly, whether the professional has expertise and experience with someone your son's age.

So, all that said -- if attention and focus are a concern, then you will need a neuropsychological evaluation. If it is his learning challenges that are manifesting behaviors of inattention and focus (i.e., difficult text is put before him and all of a sudden he can't focus) -- that's a different issue. Then, we need to get to the bottom of his learning challenges with text. Here is a bit about what a good, comprehensive language and literacy assessment entails.

When you write that he is having difficulty in math and science (albeit he may just not be a "science guy") -- this raises a flag for me as a language clinician about his spoken language skills. Spoken language is a conceptual system, as are reading and math. I'm wondering what is "tripping" him up. Is it the math computations per se for both math & science or is it the concepts? Is it his inability to remember all of the various steps to complete a math problem or science experiment (i.e., working memory)? Is it the vocabulary? I don't have information on science on the website, although here's a bit about math.

I have a similar question about writing relative to his spoken language skills. We know that if a student has difficulty with spoken language, this can affect written language. I would want to know that he has had a good assessment of his comprehension and use of spoken language. Many times, I find at my private clinical practice where this is our specialty, that assessment of oral language has been overlooked, especially in our older kids. Many professionals do not know the important relationship between oral and written language -- oral language undergirds learning to read, spell, and write.

I will admit that it can be challenging to identify exactly what is going on, particularly in an older student who is smart, but a good diagnostician should be able to get to the "bottom of this" and identify and explain a profile that makes sense to you and -- at his age -- to your son! I just started working with a 14 old boy who recently had a pretty good assessment and was diagnosed with “subclinical dyslexia.” He has a dyslexic profile of strengths and weaknesses, with weaknesses in rapid automatic naming which is an area of phonological processing and one of the hallmarks of dyslexia -- so speed is an issue for him, but he did not score poorly enough to qualify as dyslexic. The challenge is he is very bright, so has learned to compensate.

I want you to know that many successful dyslexics (and there are many of them) when talking about their younger years and their struggles in school, note the importance of someone who believed in them -- and for many, that person was a parent. He is lucky to have you advocating for him!

Let me know if you have other specific questions for me.