Clinical Case Report: A Gifted Adolescent with an Emotionally Based Learning Disability.
This 2e adolescent boy was treated by Madelon Sann, L.C S W. The example is a greatly abbreviated version of more complete clinical case report that will be included in a forthcoming paper “ A New Look at the Psychology of the 2e syndrome: Understanding and Treating It.” The paper will include a comprehensive literature review and a detailed discussion of the complex nature of the 2e phenomenon.
Eric was 13 ½ when he was referred for therapy. Since his parent’s divorce, he had been living with his mother. Intelligent, sensitive and cooperative despite their divorce, they felt Eric needed therapy for several reasons. Theirs was an unusual example of anticipating emotional problems rather than waiting for them to develop.
The high school Eric was about to enter was much closer to his father’s house than his mother’s and because his mother was returning to work full time, Eric and his parents felt it made sense for Eric to leave his mother’s home and move in with his father. The new school was a destination for the city’s elite students and had a reputation for being pressured and competitive. Every parent felt that to be a successful student there required major emotional and intellectual adjustments. Eric’s parents also felt he had never really “emotionally processed” their divorce. Eric, on the other hand, was “up for” the challenge of the new school and felt that his parents divorce had been “no big deal”. He couldn’t see the point of therapy.
Eric was identified as gifted in grade school: he consistently got very high grades in all areas with very little effort. In middle school, his teachers observed that he had a “special feel” for math and science. Completing written assignments was not quite so easy but he was always complimented on his ability to handle complex material with an unusually effective style. Good looking, popular and confident Eric objected to being sent to a therapist.
Within several weeks of starting high school, it was clear Eric was emotionally and academically overwhelmed. Initially excited by the challenge of the city’s best school, he wasn’t sure he could handle it. In middle school everyone knew he was gifted in this tough school nobody seemed to care.It was a big noisy place with an aggressive feel. In the first few weeks kids were already talking about how hard it was to get into the best colleges.
For the first time in his life, Eric found himself doing homework. The pace in classes was so intense that the material was just not going into his head the way it used to. Without taking notes, he wasn’t sure he could keep straight the details from different subjects. To make matters worse, he didn’t have any friends. Because he had been so popular, he was used to classmates approaching him for friendship. Now he felt confused and lost.
Several months into the treatment he softened his independent attitude and was willing to take suggestions for how to reach out to classmates. Finally, when some of the “jocks” discovered he was a good athlete, they invited him to play on their basketball team. Before long he had a girlfriend.
By second semester, Eric was getting top marks in math and science. Once again excellent results came with little effort. His confidence and self esteem were returning. However, his grades in English and History were stuck at the C level. The difficulty seemed to be with the writing. He just couldn’t seem to get started. He procrastinated. As deadlines approached, he began to have panic attacks. He could hardly believe this was happening to him. He was forced to request extensions. It was an odd problem because when his work was returned, it was invariably with many compliments. Over and over again it was “excellent work, interesting insights, wonderful style but because of 2 extensions I can’t give you more than a C”. Praise for one assignment never seemed to make approaching the next one any easier. He wondered if he had a short term memory deficit. Never needing to “bread a sweat” as he put it, was he rebelling against the preparation and hard work now required to get excellent grades? Or was it possible that his gifted abilities had masked a longstanding learning disability—now revealed in a more demanding environment?
A series of neuropsychological tests did in fact reveal a “ language based learning disorder” But months of efforts at remediation and attempts to master compensation strategies were largely ineffective. He described the sessions with the learning specialist as boring and said his concentration began to fall apart within 15 minutes of starting. I asked if he was embarrassed about his diagnosis but he denied it and said the was trying his best to work at it His confidence began to fade as he became increasingly discouraged. He wondered how smart he really was. I asked if there was something about the process of writing that presented some special uncomfortable meaning for him. He didn’t quite get what I meant. Soon I stopped exploring these issues with him and concentrated on being supportive and empathic about how hard all of this must be for him.
A dramatic experience in a summer writing course clarified what the writing disability was all about. It was a twice-weekly course with brief assignments due at the end of each week. The teacher was a pleasant supportive woman who freely granted extensions when necessary. This of course was a great relief to Eric. Within several weeks he distinguished himself a one of the best writers. But, as usual each assignment required an extension. The teacher wondered about the need for repeated extensions –was he a perfectionist ?—Eric told her about his disability. She emphasized that he was an excellent writer and she couldn’t imagine why he was worried about the quality of his work. Perhaps it was something else but neither of them could figure it out.
Several weeks before the end of the course the teacher announced she would give no extensions for the last assignment. With 3 days left Eric had an anxiety attack and pleaded for an extension. At first the teacher refused but, sensing his mounting panic, she agreed to an overnight extension but, as he was the only one receiving this, he needed to promise to keep it a secret from his classmates. What happened next completely stunned Eric.
As if in a trance of crystal clear thinking he wandered into and empty classroom, opened his laptop and although he had spent days of completely unproductive thinking about it wrote out his assignment within 30 minutes. Astonished, he realized he needed to make only several corrections. After completing these, he e-mailed the essay to his teacher only 1hour late. As expected, she congratulated him on his fine work.
As we went over this remarkable experience in session, Eric reflected on how his teacher gave him special consideration and began to cry. He found himself thinking about his parents divorce. For the first time he could acknowledge how sad it was. He talked about how he was completely unaware of this sadness. “I guess I thought I was smart enough to handle it myself.” As one memory lead into another, he recalled how much fun he and his mother used to have spelling writing and reading. “ It all started when she gave me foam letters to play with in the bath tub. We played with them making real words or silly words. Then words became sentences then sentences became little paragraphs. As I got older, the writing continued to be a special part of our relationship. She would help me critique my essays and reports. We debated word choice, sentence structure and paragraph sequencing”.
Further emotional and insightful sessions helped Eric understand his difficulty with time management and the need for extensions. It all seemed related to the special unhurried time he once had with his mother—a time spent without deadlines or pressured restrictions –and a part of his childhood that he was not prepared to let go—and a part that was prematurely interrupted by divorce and a need to move in with his father. The secret extension he got from his teacher, temporarily gratified his continued need for special time and broke through his “disability” to give him a moment of a kind of cognitive clarity.
Now Eric also began to understand why he had so much difficulty with learning the techniques of remediation and strategies of compensation. Mastering these would mean he would no longer need to depend on his mother or teachers for special attention. Successful use of these would also mean that his giftedness would be free to operate across all intellectual domains. Would this mean his grades would put him out in front of all his friends? Would it mean that giftedness would cause him to be isolated lonely and unhappy? He began to see the appeal of retreating into the safety of a learning disability .
Eric’s therapy continued through high school and periodically through college. After graduation he landed impressive entry level job with a management consulting firm. His written assignments all require quick responses They are all turned in on time –sometimes early.
Understanding and treating the 2e syndrome requires more than an appreciation of how giftedness can mask learning disabilities, learning disabilities can restrict giftedness or the two may simply neutralize each other. In this case –typical of many we have seen over the years- even though the learning disability was diagnosed neuropsychologically it was primarily emotionally based. The emotional issues were unresolved dependency needs and conflicts about the power of giftedness itself.
Adding a psychodynamic approach to other assessments and treatments can help a clinician better understand a particular 2e student and make other cognitive, behavioral interventions more effective.
( an abbreviated version of this case report first appeared in the May/June 2010 issue of the 2e newsletter )