Intellectually gifted individuals with specific learning disabilities are the most misjudged, misunderstood, and neglected segment of the student population and the community. Teachers, school counselors, and others often overlook the signs of intellectual giftedness and focus attention on such deficits as poor spelling, reading and writing (Whitmore & Maker, 1985)
Understanding the differential diagnosis in gifted children with ADHD is important to securing appropriate placement for their educational and social needs. Twice Exceptional students are individuals who possess an outstanding gift or talent in intellectual abilities, academics, music or the arts, but whose condition limits their overall performance and social adaptivity.
Due to the distractibility, inattention and destructive behaviors of the ADHD child educators and school psychologists do not always see the signs of giftedness or high performance in the gifted ADHD child. An accurate diagnosis for the ADHD child who is gifted is hard to place, because of this, increased efforts in research, education and interventions need to be met to help better assess and create an opportunity for misdiagnosed children and develop more literature surrounding the multi-diagnostic criteria for gifted children with presenting symptoms of ADHD.
Evolution around the terminology of “gifted” has been renegotiated by psychologists and clinicians who determine what the construct of “giftedness” should contain. Currently, there is little consensus between disciplines regarding the exact criteria that should be used to identify a gifted child (Neihart et al., 2002), however, IQ is not the only variable that is considered within the domains for the consideration of giftedness. Typically, giftedness is seen as a high desire or aptitude to master a large range of passions over time. Traits typically associated with giftedness include high cognitive reasoning, passion for mastery and higher levels of emotional sensitivity.
The National Association of Gifted Children describes giftedness as “the distinct categories of ability, acknowledging that exceptional performance can occur across different domains such as creative thinking, the arts and intellectual ability.” (Radisavljevic, 2011).
The dual diagnosis of ADHD and giftedness or “twice exceptional” students can leave gifted children with co-morbid learning disabilities without proper educational placement to help regulate their high psychomotor activity and stimulate their overactive neurocognition. Likewise, there appears to be relevant overlap in the research and literature designed for deciphering the behavioral adaptations of gifted children and ADHD children.
In the 1960s, Dabrowski presented a key paper in helping develop the conceptual model around the personality and definition of how gifted children process and retain data information. The five areas that Dombrowski focused on were what he labeled as, “psychic overexcitabilities” (Dombrowski, 1964).
Dombrowski was a polish psychologist that identified five domains in gifted children’s behavior that makes them substantially different than non-gifted children, apart from academic excellence and high performance.
Dombrowski’s five areas of overexcitabilities include:
- Psychomotor – this is seen in higher levels of psychomotor cognition and hyperactive behavior. Signs include nervous habits, tics, competitiveness and compulsive talking.
- Sensual – this includes, a heightened awareness of the senses. Gifted children may find beauty and appreciation for art, literature and existence enduring at younger ages.
- Intellectual – This includes activities of the mind and is comprised of characteristics associated to deep curiosity, love of knowledge and avid reading.
- Imaginative – divergent thinking and associations with free play are associated with imagination. This includes a love of music, poetry and magical thinking
- Emotional – Exceptional emotional sensitivity on a wide spectrum of positive and negative affect.
In studies developed by psychologists (Ackerman and Paulus, 1997, Bouchard, 2004) interested in understanding the differences between gifted and non-gifted children. Dombrowski’s overexcitabilities were tested on school children that comprised a norm group of academically superior individuals with an average IQ of over 120. In the study, psychomotor excitability appeared to the largest discriminator between gifted and non-gifted children, including intellectual overexcitabilities being provided as significant differences within the norm groups.
Behaviors that resemble psychomotor overexcitability include “blurting out answers, jiggling their feet, and getting off task.” (Radisavljevic, 2011). However, these psychomotor excitabilities are highly reminiscent of the common DSM-V criteria for diagnosing ADHD which includes sub-scales of hyperactivity and inattention.
The Gifted Child with ADHD: Assessing ADHD in Gifted Children
Because of the commonalities observed in gifted children’s behavior versus the child with ADHD, determining true attention deficits from the range and temperament of the gifted child can be difficult. However, recent evidence supports the validity of a dual-diagnosis. For instance, Antshel et al. (2007) noted that gifted children with ADHD show a pattern of cognitive, psychiatric and behavioral characteristics consistent with the diagnosis of ADHD documented in children with an average IQ (Mullet et al. 2015). In a study by Corderio et al’s (2011), there was substantial evidence that pointed to 10 out of 15 intellectually gifted children who in their study met the DSM-IV diagnostic criteria for ADHD.
Understanding the difference between the “twice exceptional” gifted child and a normal gifted child is usually typically seen in the child’s social interactions and behavior. For instance, “The creatively gifted child may appear to be oppositional, hyperactive, and argumentative (Cramond, 1994). Gifted children with some kinds of undiagnosed learning disabilities will be very disorganized, messy, and have difficult social relations (Baum & Owen, & Dixon, 1991; Olenchak & Reis, 2002).
Considerations Made for ADHD Children and the Wechsler Intelligence Scale
Cognitive functioning is an important factor to look at when delivering a dual diagnosis for the gifted ADHD child. For instance, Antshel (2008) summarized previous findings that indicated that by having ADHD, gifted children are less likely to perform highly on the Wechsler Intelligence Scale for Children (Wechsler, 1991). This is due to the psychomotor and test-taking response time scales of the Wechsler exam. The processing speed and working memory measures of the Wechsler exam do not take into account the distractibility range of the ADHD child and has shown to depress the overall scores. In conjunction, children with gifted ADHD also show to test well in the scales of test that appear to be more cognitively complex but score lower in scales that are simple. Inter-rater differences in test scores provide that standardized testing is not always the best determinant to use when testing for giftedness and intelligence amongst the ADHD population. It appears that gifted students with ADHD struggle with utilizing cognitive skills when performing psychomotor speed tests and overall memory recall. Due to the impaired executive functioning in the ADHD child, attributes like “prioritizing, planning, detailing, managing emotions and using working memory” are all deficits that the ADHD gifted child is faced with.
Neurological Connection Between Creativity and ADHD
Creativity in ADHD is a typical association with the disorder. In a study by Cramond (2006) the psychologist found that nearly 26% of highly creative children have a dual-diagnosis of ADHD.
Likewise, researchers have found that ADHD gifted students also have a stronger positive correlation to creativity than gifted students without ADHD. Healey and Rucklidge (2006) noted that 40% of creatively gifted students displayed significant levels of ADHD symptomology versus 9% expected in the general population. Research identifies the key components between the creatively gifted child and the creatively gifted child with ADHD and discovered that the core psychomotor processing skills in executive functioning appear to be what differentiates the two. Again, children with ADHD have a harder time processing information and remembering skills typically used for advanced placement.
Making a Differential Diagnosis
A multi-factor assessment model is needed when determining the co-morbidity of learning disabilities within gifted children and should be handled by neuropsychologists who understand the neuro-cognitive difficulties of the ADHD child and Clinicians who are trained in understanding the intricate developmental characteristics of gifted children.
Twice-exceptional assessments should include screening for intelligence, creativity and co-morbid mental health issues like ADHD and depression.
Non-standardized assessments taken from the APAcenter (2018) for screening include:
- Clinical interviews
- Standardized tests of visual and auditory attention
- Achievement across areas of different constructions (i.e., excellence in visual and performing arts)
- Behavioral checklists completed by parents, teachers, and students
- Psychological/ projective measures to help with the assessment process
More Notes on Identification | Behavioral Checklists
Children who are diagnosed ADHD and show signs of creativity do not always have indicators of high academic performance. This could be because of a multitude of reasons from considering disruptive behavior, executive functioning and hyperactive psychomotor capabilities. Conversely, learning disabilities tend to depress ability on achievement test scores, thus making identification of giftedness hard to spot.
A behavioral checklist can help with the diagnosis of giftedness in ADHD children. Students who are gifted with learning disorders display cognitive strengths as well as distinct behavioral and emotional signs.
This checklist of behavioral and cognitive signs was pulled from the William & Mary Training and Technical Assistance Center for Twice Exceptional: Gifted Students with Learns Disabilities Consideration Packet. https://education.wm.edu/centers/ttac/documents/packets/twiceexceptional.pdf
There were no official standardized validity/ reliability scores for this behavioral checklist. Due to the behavioral checklist being a form of observation when assessing for different behavioral characteristics in ‘twice exceptional’ students.
- Superior vocabulary
- Uninhibited expression of opinions
- Uncanny sense of humor (e.g., sophisticated use of metaphor)
- Highly imaginative
- Extreme creativity
- Extreme sensitivity and intensity
- Penetrating insights
- High levels of problem solving and reasoning
- Interest in the “big” picture
- Specific talent in a consuming interest area for which students have exceptional memory and knowledge
- A wide range of interests that are not related to school learning
- Discrepant verbal and nonverbal performance abilities
- Deficient or extremely uneven academic skills
- Auditory, perceptual, or visual perception problems
- Problems with long- and/or short-term memory
- Perceptual-motor difficulties evidenced by clumsiness, poor handwriting, or problems completing fine-motor tasks
- Slow responses; students may appear to work slowly and think slowly
- Lack of organizational and study skills; often messy
- Difficulty following directions; nonlinear thinking
- Easily frustrated: students give up quickly on tasks; will not risk being wrong or making mistakes
- Lack of academic initiative; appear academically unmotivated; avoid school tasks; frequently fail to complete assignments
- Difficulty expressing ideas and getting to the point; difficulty expressing feelings
- Blaming others for their problems
- Distractibility; difficulty maintaining attention for long periods of time
- Difficulty controlling impulses
- Poor social skills: students may demonstrate antisocial behaviors
- Over-sensitivity to criticism
- Lack of ability to critically self-evaluate strengths and weaknesses
Markers of the Combination of Giftedness and Learning Disabilities
- Poor memory for isolated facts, but excellent comprehension
- Preference for complex and challenging materials; easily distracted
- Lacking self-regulation and goal-setting strategies
- Boredom with rote or memorization tasks, but often disorganized
- Difficulty reading, writing or spelling, but excellent oral language skills
- Skill in manipulating people and situations, but poor interpersonal skills
- Poor performance on simple facts such as addition and subtraction, but capable of complex, conceptual manipulations such as algebraic concepts
- Strong sense of humor, but an inability to judge appropriate times to display it
- Penetrating insights, but an inability to determine cause and effect related to own actions
- Ability to concentrate for unusually long periods of time when the topic is of interest, but an inability to control his or her actions and attention when the topic is not of interest
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