Gidtedness : Misdiagnosis Problems
Many gifted and talented children (and adults) are being mis-diagnosed by psychologists, psychiatrists, pediatricians, and other professionals. The most common mis-diagnoses are: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorde Obsessive Compulsive Disorder (OCD), and Mood Disorders such as Cyclothymic Disorder, Dysthymic Disorder, Depression and Bi-Polar Disorder. These common mis-diagnoses stem from an ignorance among professionals about specific so emotional characteristics of gifted children which are then mistakenly assumed by these professionals to be signs of pathology.
In some situations where gifted children have received a correct diagnosis, giftedness is still a factor that must be considered in treatment and should generate a dual diagnosis (2e). For example, existential depression or learning disability, when present in gifted children o requires a different approach because new dimensions are added by the giftedness component. Yet the giftedness component typically overlooked due to the lack of training and understanding by health care professionals (Webb & Kleine, 1993).
Despite prevalent myths to the contrary, gifted children and adults are at particular psychological risk due to both internal characteristics and situational factors. These internal and situational factors can lead to interpersonal and psychological difficulties for gifted children that subsequently lead to mis-diagnoses and inadequate treatment.
Intensity, sensitivity, idealism, impatience, questioning the status quo–none of these alone necessarily constitutes a problem. In fact, we generally value these characteristics and behaviors–unless they happen to occur in a tightly structured classroom, or in a highly organized business setting, or if they happen to challenge tradition, and gifted children are the very ones who challenge traditions or the status quo.
There is a substantial amount of research to indicate that gifted children spend at least one-fourth to one-half of the regular classroom waiting for others to catch up. Boredom is rampant because of the age tracking in our public schools. Peer relations for gifted children are difficult (Webb, Meckstroth and Tolan, 1982; Winner, 2000), all the more so because of the internal dyssynchrony (asynchronous devel shown by so many gifted children where their development is uneven across various academic, social, and developmental areas, an their judgment often lags behind their intellect.
Clearly, there are possible (or even likely) problems that are associated with the characteristic strengths of gifted children. Some o typical strengths and related problems are shown below:
Strengths and Possible Problems That May be Associated with Giftedness
- Acquires and retains information quickly.
- Inquisitive attitude, intellectual curiosity; intrinsic motivation; searching for significance.
- Ability to conceptualize, abstract, synthesize; enjoys problem- solving and intellectual activity.
- Can see cause–effect relations.
- Love of truth, equity, and fair play.
- Enjoys organizing things and people into structure and order; seeks to systematize.
- Large vocabulary and facile verbal proficiency; broad information in advanced areas.
- Thinks critically; has high expectations; is self-critical and evaluates others.
- Keen observer; willing to consider the unusual; open to new experiences.
- Creative and inventive; likes new ways of doing things.
- Intense concentration; long attention span in areas of interest; goal- directed behavior; persistence.
- Sensitivity, empathy for others; desire to be accepted by others.
- High energy, alertness, eagerness; periods of intense efforts.
- Independent; prefers individualized work; reliant on self.
- Diverse interests and abilities; versatility.
Potential Problems:
- Impatient with slowness of others; dislikes routine and drill
- Resists mastering foundational skills; may make concepts unduly complex.
- Asks embarrassing questions; strong-willed; resists direction seems excessive in interests; expects same of others.
- Rejects or omits details; resists practice or drill; questions te procedures.
- Difficulty accepting the illogical-such as feelings, traditions, o matters to be taken on faith.
- Difficulty in being practical; worry about humanitarian causes
- Constructs complicated rules or systems; may be seen as rude, bossy or domineering.
- May use words to escape or avoid situations; becomes bore school and age-peers; seen by others as a “know it all.”
- Critical or intolerant toward others; may become discouraged depressed; perfectionist.
- Overly intense focus; occasional gullibility.
- May disrupt plans or reject what is already known; seen by o as different and out of step.
- Resists interruption; neglects duties or people during period focused interests; stubbornness.
- Sensitivity to criticism or peer rejection; expects others to ha similar values; need for success and recognition; may feel different and alienated.
- Strong sense of humor.
- Frustration with inactivity; eagerness may disrupt others’ schedules; needs continual stimulation; may be seen as hyperactive
- May reject parent or peer input; non-conformity; may be unconventional.
- May appear scattered and disorganized; frustrations over lac time; others may expect continual competence.
- Sees absurdities of situations; humor may not be understood peers; may become “class clown” to gain attention. Clark (1992) and Seagoe (1974).
- Lack of understanding by parents, educators, and health professionals, combined with the problem situations (e.g., lack of appro differentiated education) leads to interpersonal problems which are then mis-labeled, and thus prompt the mis-diagnoses.
The most common mis-diagnoses are as follows:
ADHD. Many gifted children are being mis-diagnosed as Attention Deficit Hyperactivity Disorder. The gifted characteristics of intensity, sensitivity, impatience, and high motor activity can easily be mistaken for ADHD. Some gifted children suffer from ADHD, and thus have a dual diagnosis of gifted and ADHD; but in my opinion, most are not. Professionals need to ask if child’s inattentiveness or impulsivity behaviors occur only in some situations but not in others (e.g., at school but not at home; at church not at scouts, etc.). If the problem behaviors are situational only, the child is likely not suffering from ADHD.
Bi-Polar and other Mood Disorders. Many gifted children can experience intense mood swings and marked depressed mood, especially if they are going through a situational trigger such a s family problems, divorce, relocation or even bad parenting.
Obsessive-Compulsive Disorder. Even as preschoolers, gifted children love to organize people and things into frameworks, and get quite upset when others don’t follow their rules or don’t understand their schema. Many gifted first graders are perfectionist and “bossy” because they try to organize the other children, and sometimes even try to organize their family or the tea they grow up, they continue to search intensely for the “rules of life” and for consistency. Their intellectualizing, sense of u perfectionism, idealism, and intolerance for mistakes may be misunderstood to be signs of Obsessive-Compulsive Disorder or Ob Compulsive Personality Disorder. In some sense, however, giftedness is a dual diagnosis with Obsessive-Compulsive Personality since intellectualization may be assumed to underlie many of the diagnostic criteria for this disorder.
Austism Spectrum Disorder/Asperger’s Syndrome. Although there can be similarities between a gifted child and a child with Asperger’s Disorder, there clear differences. Thorough evaluation is necessary to distinguish gifted children’s sometimes unusual and sometimes unique interactions from Asperger’s Disorder. In the same way, thorough evaluation is also necessary to distinguish Attention-Deficit/ Hype Disorder (ADHD) from behavioral problems and inattention that result from other causes such as anxiety, traumatic experiences (e.g., inappropriate curriculum, or even poor parenting. A “qualitative impairment” in social interaction is one of the two main character Asperger’s Disorder. Although the DSM-IV gives fairly explicit criteria for this type of social impairment, which does sometimes appear kids, the highly gifted child’s atypical social interactions or unusual modes of commenting and joking may often be misinterpreted a characteristics of Asperger’s Disorder. However, a closer look at the criteria shows differences between Asperger’s Disorder and be associated with gifted children. For example, a lack of social or emotional reciprocity is characteristic of Asperger’s Disorder.
Dual Diagnoses
Learning Disabilities and Giftedness. Giftedness is a coexisting factor, to be sure, in some diagnoses. One notable example is in d and treatment of learning disabilities. Few psychologists are aware that inter-subscale scatter on the Wechsler intelligence tests increase child’s overall IQ score exceeds 130. In children with a Full Scale IQ score of 140 or greater, it is not uncommon to find a difference more points between Verbal IQ and Performance IQ (Silverman, 1993; Webb & Kleine, 1993; Winner, 2000). Most clinical psychologist are taught that such a discrepancy is serious cause for concern regarding possible serious brain dysfunction, including a learning disability. But in highly gifted children, such discrepancy is far less likely to be an indication of pathological brain dysfunction, though it certainly would an unusual learning style and perhaps a relative learning disability.
Similarly, the difference between the highest and lowest scores on individual subscales within intelligence and achievement tests is often notable in gifted children. On the Wechsler Intelligence Scale for Children, it is not uncommon to find subscale differences greater thatn seven scale score points for gifted children, particularly those who are highly gifted. These score discrepancies are taken by psychologists to indicate learning disabilities, and in a functional sense they do represent that. That is, the levels of ability do vary dramaticlly though the range may be “only” from Very Superior to Average level of functioning. In this sense, gifted children may not “qualify diagnosis of learning disability”, and indeed some schools seem to have a policy of “only one label allowed per student,” and since this is gifted, he/she can not also be considered learning disabled. However, it is important for psychologists to understand the con “asynchronous development” (Silverman, 1993), and to appreciate that most gifted children show such an appreciable, and often significant scatter of abilities.
Poor handwriting and Giftedness is often used as one indicator of learning disabilities. However, many and perhaps most gifted children will show sloppy handwriting. Usually this simply represents that their thoughts go so much faster than their hands can move, and that they see little s making writing an art form when its primary purpose is to communicate (Webb & Kleine, 1993; Winner, 2000).
Psychologists must understand that, without intervention, self-esteem issues are almost a guaranteed in gifted children with learning disabilities as well as those who simply have notable asynchronous development since they tend to evaluate themselves based more on what they do rather than on what they are able to do. Sharing formal ability and achievement test results with gifted children about their p abilities, combined with reassurance, can often help them develop a more appropriate sense of self-evaluation.
Sleep Disorders and Giftedness. Nightmare Disorder, Sleep Terror Disorder, and Sleepwalking Disorder appear to be more prevalent in gifted children, particularly boys. It is unclear whether this should be considered a mis-diagnosis or a dual diagnosis. Certainly, commonly report that their gifted children have dreams that are more vivid, intense, and more often in color, and that a substantial prop gifted boys are more prone to sleepwalking and bed wetting, apparently related to their dreams and to being more soundly (i.e., in asleep. Such concordance would suggest that giftedness may need to be considered as a dual diagnosis in these cases, or at least worthy of consideration since the child’s intellect and sense of understanding often can be used to help the child cope with nightmares.
A little known observation concerning sleep in gifted individuals is that about twenty percent of gifted children seem to need significant less sleep than other children, while another twenty percent appear to need significantly more sleep than other children. Parents report the sleep patterns show themselves very early in the child’s life, and long-term follow up suggests that the pattern continues into adulthood & Kleine, 1993; Winner, 2000). Some highly gifted adults appear to average comfortably as few as two or three hours sleep each ni they have indicated to me that even in childhood they needed only four or five hours sleep.
Multiple Personality Disorders and Giftedness. Though there is little formal study of giftedness factors within MPD, there is an evidence that the two are related. The conclusion of professionals at the Menninger Foundation was that most MPD patients showed a of childhood abuse, but also high intellectual abilities which allowed them to create and maintain their elaborate separate personalities.
Relational Problems. These children can be both exhilarating and exhausting. But because parents often lack information about character gifted children, the relationship between parent and child can suffer. The child’s behaviors are seen as mischievous, impertinent, strong-willed, and the child often is criticized or punished for behaviors that really represent curiosity, intensity, sensitivity, or the judgment behind intellect. Thus, intense power struggles, arguments, temper tantrums, sibling rivalry, withdrawal, underachievement, a flaunting of family and societal traditions may occur within the family.
“Impaired communication” and “inadequate discipline” are specifically listed in the DSM-IV (1994) as areas of concern to be conside diagnosis of Parent-Child Relational Problems, and a diagnosis of Sibling Relational Problem is associated with significant impair functioning within the family or in one or more siblings. Not surprisingly, these are frequent concerns for parents of gifted children du intensity, impatience, asynchronous development, and lag of judgment behind intellect of gifted children.
In conclusion many of our brightest and most creative minds are not only going unrecognized, but they also are often given diagnoses that pathology. For decades, psychologists and other health care professionals have given great emphasis to the functioning of person lower range of the intellectual spectrum. It is time that we trained health care professionals to give similar attention to our gifted, talented and creative children and adults. At the very least, it is imperative that these professionals gain sufficient understanding so that they avoid concluding that certain inherent characteristics of giftedness represent pathology.
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