Does Your Gifted Child Have ADD

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Does your Gifted Child have ADD (ADHD)? Kathleen Nadeau, Ph.D. A parent who searches the internet for information on gifted children with ADD (ADHD) will find an array of confusing and contradictory information. The public's stereotyped image of a child with ADD (ADHD) is typically a young boy who does poorly in school, who is impulsive, highly distractible, and often has behavior problems at home and at school. Given this negative image of ADD (ADHD), it's no wonder that many articles argue against using this label for gifted students. One such article characterizes the child with ADD (ADHD) as having poor attention "in almost all situations," with little ability to persist at tasks, a child who is impulsive, restless, and has difficulty obeying rules and regulations - in other words, a "bad" kid. What many parents, and even many professionals, may not know is that our understanding of ADD (ADHD) has evolved significantly over the past ten to fifteen years. While there is certainly a subgroup of challenging children who function poorly at school and at home, there are many children with ADD (ADHD) whose behavior and performance bears very little resemblance to the difficult, disruptive child described above. What do bright students with inattentive ADD (ADHD) look like? Children of above average intelligence, with few hyperactive/impulsive symptoms, typically pose no behavior problems in the classroom and often work hard to hide their ADD (ADHD) struggles - especially if they are female. These children often do well in elementary school, where their intelligence more than compensates for the challenges posed by ADD (ADHD). For some of these bright students, their unraveling begins in middle school when the demands for productivity, independence, and organization increase dramatically. This is a time when there is a sharply increased demand on the "executive functions" of the brain. Because most research on ADD (ADHD) has been conducted on elementary school aged children, we have not paid adequate attention to executive function problems associated with ADD (ADHD). In elementary school, we do not expect children to monitor themselves, to keep track of time accurately, to keep their own schedule, or to plan, organize and prioritize. A child's mother, father, and teacher take responsibility for most of these functions. Then suddenly, as a child enters middle school, he or she is faced with a complex schedule, multiple teachers, and greatly increased organizational demands. I will always remember a highly gifted student with ADD (ADHD) whom I evaluated a number of years ago. He had just gained admission to a highly competitive public science and technology magnet high school. A ninth grader very small for his age, he told me of his efforts to keep up with the demands. Unable to organize his books and papers well, he found that he often arrived in class without all of the necessary items. Often, they had been left in his locker. His solution to this problem was to carry ALL books and papers with him at all times in a huge backpack that he could barely carry. To add insult to injury, he tearfully reported that efforts to be sure he had what he needed in all of his classes were criticized by a teacher who told him that he was not

allowed to carry such a large backpack through the crowded school hallways. "That's what your locker is for!" she exclaimed. In this instance, the burden of struggling with ADD (ADHD) was quite literal - a backpack that this student could barely carry combined with criticism rather than understanding of his intense efforts to keep up. Other gifted students with ADD (ADHD) continue to function well academically, at least on paper, through high school. Their behind-the-scenes behaviors tell a different story, however chronic anxiety, all-night study sessions prior to exams, homework that takes hours longer than their gifted non-ADD(ADHD) counterparts, struggles with procrastination, and last-minuite completion of papers and projects. While their grades may look good, their ADD (ADHD) symptoms are increasing as demands increase. A number of students with ADD (ADHD) may not encounter significant struggles until they are away at college - where the structures, routines, and supports of home are suddenly missing. Some parents, desperate to help their son or daughter succeed in college, resort to becoming their child's long-distance coach, calling to wake them in the morning, keeping detailed track of assignments and exam dates and constantly reminding and advising their child regarding daily to-do's and routines. The more academically inclined and more intelligent the student with ADD (ADHD), the later he or she begins to encounter serious challenges related to ADD (ADHD). Some with ADD (ADHD), for example, graduate from medical school, but are unable to pass their medical boards, or complete all course requirements for a Ph.D., but never complete the dissertation. The possibility of ADD (ADHD) should not be rejected because your child is currently doing well academically. Even when academic performance is high, the hidden cost of ADD (ADHD) may be taking a toll. Gifted students with ADD (ADHD) often struggle with anxiety, even when grades are high. They may also suffer when required to do unnecessary, repetitive work that less gifted students may need, but which only serves as a frustration for a gifted student. When should you consider the possibility of ADD (ADHD) in your gifted child? 1. Do others in the family show signs of ADD (ADHD)?  

  

Do any siblings show more obvious signs of ADD (ADHD)? Do either of the parents show signs of ADD (ADHD) - albeit undiagnosed - for example, problems with organization, planning, time management, forgetfulness, and difficulty with paperwork? Is either parent very bright, but didn't go as far in school as would be expected? What about grandparents? Aunts and uncles? ADD (ADHD) rarely exists in a vacuum. It's a family affair (as is giftedness).

2. Then consider the following questions about your gifted child:

1. Does your child have a poor sense of time? 2. Does your child struggle with procrastination, typically beginning homework when it's nearly time for bed? 3. Is your child a night owl who seems to get a "second wind" later in the evening? 4. Is your child an "absent-minded professor"? 5. Does your child hyper-focus to the extent that he or she doesn't hear you when you call? 6. Is your child a dawdler who has great difficulty getting up on time in the morning, and getting ready for school once he or she is out of bed? 7. Is he or she very likely to misplace personal items - jackets, keys, wallets, etc.? 8. Do you find that you need to repeat multi-step directions because your child hasn't registered all of the steps? 9. Do you send your child upstairs for something only to find that they have completely forgotten their mission and are sidetracked by something else? The child described above presents a very different picture from the stereotyped child with ADD (ADHD) who is impulsive, over-active, with a short attention span and little inclination to follow the rules. What happens when inattentive type ADD (ADHD) is combined with giftedness? Sometimes, ADD (ADHD)-like traits are intensified! For example, read Web's (1993) description of gifted children. According to Web:     

gifted children often daydream and pay little attention with not interested (ditto for ADD (ADHD)!); they have low tolerance for tasks that seem irrelevant (ditto for ADD (ADHD)!); they may have a high activity level with little need for sleep (ditto for ADD (ADHD)!); they may be emotionally intense and engage in power struggles (ditto for ADD (ADHD)!); and they may often question rules and traditions (ditto for ADD (ADHD)!).

What are the risks when ADD (ADHD) is overlooked in gifted children? Sadly, sometimes "giftedness" and "ADD (ADHD)" seem to cancel each other out - in the eyes of the school and in the eyes of the student him or herself. For example, a college freshman was referred to me by her very concerned mother when "Rose" found herself feeling overwhelmed by the demands of managing her life as a college student away from home for the first time. Rose's mother believed, accurately, that Rose was a gifted student with ADD (ADHD). Rose, however, believed that she was neither gifted nor ADD (ADHD). As Rose put it, "I know what gifted is. Lots of my friends in high school were gifted. They didn't need to study nearly as long as I did. They made better grades, and they got higher scores on their SATs. If I were gifted, I wouldn't be having the problems I'm having now!" Rose denied her ADD (ADHD) as well. "I don't know why my mother thinks I have ADD (ADHD). I'm not at all like the kids I knew in school with ADD (ADHD) - the ones who took Ritalin. They never read or studied. They were hyper and hated school. I'm not like that. I read all the time and I'm certainly not hyper!"

For Rose, and for many gifted students like her, her giftedness was masked by untreated ADD (ADHD), and her ADD (ADHD) went unrecognized because Rose didn't fit the ADD (ADHD) stereotype. The cost for this hidden disorder - demoralization and chronic under-functioning. What should a parent do if they suspect their gifted child has ADD (ADHD)? First, they should seek an evaluation by the best-qualified professional that they can find. Parents should make sure that the professional they select has experience evaluating gifted students with ADD (ADHD). Parents need to learn more about what ADD (ADHD) looks like in bright, inattentive ADD (ADHD) students, and help their son or daughter to learn about this too. Parents who suspect that they too have ADHD should talk openly to their son or daughter about their own struggles. They should help their gifted son or daughter understand that struggles with postponed assignments, sleep difficulties, incomplete homework, careless errors on tests, and unpredictable memory lapses may all be part of a very treatable condition. It's important that parents also teach their gifted son or daughter about the very positive traits often shared by gifted individuals with ADD (ADHD):    

patterns of "divergent" thinking that can lead to rare insight, a wealth of creative ideas, an ability to hyper-focus, and tremendous drive and energy that can be brought to bear on an activity when a gifted person with ADD (ADHD) directs his attention toward activities that are in his areas of strength and interest.

Parents should seek comprehensive treatment. Studies suggest that the most effective treatment for ADD (ADHD) combines stimulant medication with solution-focused, cognitive/behavioral counseling. Parents shouldn't delay if they suspect ADD (ADHD) in their gifted child. Even if their child is doing well in school, the cost of doing well only increases as demands and expectations increase. But more importantly, ADD (ADHD) is a quality-of-life disorder that can affect all aspects of life. Untreated ADD (ADHD) can have a negative impact on self-esteem, on peer relations, and can lead to chronic sleep difficulties, and to chronic stress that may develop into anxiety and/or depression as life becomes increasingly challenging. The great advantage of an early diagnosis is that a gifted child will have a better opportunity to make critical life decisions that are more ADD (ADHD)-friendly, and will have a greater chance of reaching his or her true potential.

Attention Deficit Hyperactivity Disorder (ADHD) is the most common behavioral disorder of childhood, and is marked by a constellation of symptoms including immature levels of impulsivity, inattention, and hyperactivity (American Psychiatric Association, 1994). The National Institutes of Health declared ADHD a "severe public health problem" in its consensus conference on ADHD in 1998. In the ongoing dialogue about ADHD in gifted children, three questions often arise. Are gifted children over-diagnosed with the disorder? In what ways are gifted ADHD children different from gifted children without the disorder and from other ADHD children? Does the emerging research suggest any differences in intervention or support? There are three subtypes of ADHD: predominantly inattentive type, predominantly hyperactive/impulsive type, and combined type. The combined type is most common and best researched. The DSM-IV states that to meet criteria for a diagnosis of Combined Type ADHD, a child must meet at least six of the nine criteria from both lists and exhibit significant impairment in functioning. Symptoms must occur in more than one setting, have been present for at least six months, and have been present before the age of seven. It is important to note that a child who meets the criteria but doesn't exhibit significant impairment is not diagnosed with the disorder. The subjective determination of what constitutes significant impairment is one of several factors that contribute to the controversy regarding diagnosis and treatment, especially in gifted children. Differences in Gifted Children and Non-Gifted Children with ADHD Initial findings suggest two points for consideration (Kalbfleisch, 2000; Kaufmann, Kalbfleisch, & Castellanos, 2000; Moon, 2001; Moon, Zentall, Grskovic, Hall, & Stormant, 2001; Zentall, Moon, Hall, & Grskovic, 2001). First, Kaufman and her colleagues' (2000) work indicates that identified gifted ADHD children are more impaired than other ADHD children, suggesting the possibility that we are missing gifted children with milder forms of ADHD. Second, high ability can mask ADHD, and attention deficits and impulsivity tend to depress the test scores as well as the high academic performance that many schools rely on to identify giftedness. Also, teachers may tend to focus on the disruptive behaviors of gifted ADHD students and fail to see indicators of high ability. These delays are of concern because early provision of appropriate services is important for academic and social success. Gifted children whose attention deficits are identified later may be at risk for developing learned helplessness and chronic underachievement (Moon, 2001). ADHD children whose giftedness goes unrecognized do not receive appropriate educational services. It is recommended that children who fail to meet test score criteria for giftedness and are later diagnosed with ADHD be retested for the gifted program (Baum, Olenchak, & Owen, 1998; Moon, 2002). As a group, ADHD children tend to lag two to three years behind their age peers in social and emotional maturity (Barkley, 1998). Gifted ADHD children are no exception (Kaufmann & Castellanos, 2000; Moon, 2001; Zentall, Moon, Hall, & Grskovic, 2001). This finding has important implications for educational placement. As a group, gifted children without ADHD tend to be more similar in their cognitive, social, and emotional development to children two to

four years older than children their own age (Neihart, Reis, Robinson, & Moon, 2002). When placed with other high ability children without the disorder, ADHD children may find the advanced maturity of their classmates a challenge they are ill prepared for. Also, gifted children without the disorder may have little patience for the social and emotional immaturity of the gifted ADHD student in their midst. This is not to say that gifted ADHD students should not be placed with other gifted students. The research is clear that lack of intellectual challenge and little access to others with similar interests, ability, and drive are often risk factors for gifted children (Neihart, Reis, Robinson, & Moon, 2002), contributing to social or emotional problems. Assessing ADHD in Gifted Children It is difficult to differentiate true attention deficits from the range of temperament and behavior common to gifted children. There is concern in the literature that clinicians err on the side of pathologizing normal gifted behavior (Baum, Olenchak, & Owen, 1998; Baum, Owen & Dixon, 1991; Cramond, 1995; Leroux & Levitt-Perlman, 2000; Webb, 2001). Common characteristics of gifted children can be misconstrued as indicators of pathology when the observer is unfamiliar with the differences in the development of gifted children. This difficulty can be exacerbated when the gifted child in question spends considerable time in a classroom where appropriate educational services are not provided. The intensity, drive, perfectionism, curiosity, and impatience commonly seen in gifted children may, in some instances, be mistaken for indicators of ADHD (Baum, Olenchak, & Owen, 1998; Webb, 2001). The creatively gifted child may appear to be oppositional, hyperactive, and argumentative (Cramond, 1995). 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). Ideally, a diagnosis of ADHD in gifted children should be made by a multidisciplinary team that includes at least one clinician trained in differentiating childhood psychopathologies and one professional who understands the normal range of developmental characteristics of gifted children. Since as many as two thirds of children with ADHD have coexisting conditions such as learning disabilities or depression, assessment must include an evaluation for these disorders as well (American Academy of Pediatrics, 2000). School personnel rarely have the training needed to differentially diagnose ADHD, and few clinicians are aware of the unique developmental characteristics of gifted children. Accurate assessment must be a team effort. One of the reasons parents may be hesitant to comply with treatment recommendations for their children is because they aren't convinced their child has the disorder. Parents want a thorough evaluation, and parents of gifted children want assurance that their child's giftedness has been taken into consideration when evaluations are conducted. When parents see that their child has been properly evaluated, they may be more willing to participate in a treatment plan. What is Appropriate Intervention and Support? The available research suggests that we should not assume that all interventions recommended for ADHD children are appropriate for gifted children who have the disorder. Early findings suggest that there may be some differences in the way we intervene with gifted ADHD children. Treatment matching is crucial. Effective interventions are always those that are tailored to the

unique strengths and needs of the individual. There is wide agreement in the literature on gifted children with learning problems that as a general strategy, intervention should focus on developing the talent while attending to the disability. Keeping the focus on talent development, rather than on remediation of deficits, appears to yield more positive outcomes and to minimize problems of social and emotional adjustment (Baum, Owen & Dixon, 1991; Olenchak, 1994; Olenchak & Reis, 2002; Reis, McGuire, & Neu, 2000). In addition, there is limited evidence that some of the commonly recommended interventions for ADHD children may make problems worse for ADHD children who are also gifted (Moon, 2002). For instance, since gifted children tend to prefer complexity, shortening work time and simplifying tasks may increase frustration for some gifted ADHD students who would handle better more difficult and intriguing tasks. Similarly, decreasing stimulation may be counterproductive with some gifted ADHD children who, as a group, tend to be intense and work better with a high level of stimulation. Conclusion There has been some concern that problems with inattention or hyperactivity that are better attributed to a mismatch with the curriculum (Baum, Olenchak, & Owen, 1998; Webb, 2001) or to characteristics of high creative ability (Cramond, 1995) are wrongly attributed to ADHD. Although there are good reasons to believe that misidentifications occur, there are yet no hard data on the frequency with which gifted children are over- (or under-) diagnosed or over- (or under-) medicated. Until systematic studies are conducted, we should be cautious about rejecting ADHD diagnosis in gifted children out of hand because there are serious, long-term negative consequences for undertreating the disorder (Barkley, 1998). The available research on ADHD children indicates that nationally, there is a good deal of undertreatment as well as some overtreatment of ADHD children. It is a challenge to arrange a good fit in school for gifted ADHD children. They must have an appropriate level of intellectual challenge with supports and interventions to address their social and emotional immaturity. Placement in the gifted program may or may not be appropriate, depending on the nature of the program, the social milieu of the gifted classroom, and the coping ability of the child, but a coherent plan for addressing the student's intellectual, social, and behavioral needs is nevertheless imperative. References American Academy of Pediatrics (2000). Clinical practice guidelines: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics, 105:1158-1170. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. Washington, DC: Author. Barkley, R.A. (1998). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York, NY: Guilford Press.

Baum, S.M., Olenchak, F.R., & Owen, S.V. (1998). Gifted students with attention deficits: Fact and/or fiction? Or, can we see the forest for the trees? Gifted Child Quarterly, 42, 96-104. Baum, S, Owen, S.V., & Dixon, J. (1991). To be gifted and learning disabled: From definition to practical intervention strategies. Mansfield Center, CT: Creative Learning Press. Kalbfleisch, M.L. (2000). Electroencephalographic differences between males with and without ADHD with average and high aptitude during task transitions. Unpublished doctoral dissertation, University of Virginia, Charlottesville. Kaufmann, F.A., & Castellanos, F.X. (2000). Attention-deficit/hyperactivity disorder in gifted students. In K.A. Heller, F.J. Monks, R.J. Sternberg, & R.F. Subotnik (Eds.), International handbook of giftedness and talent. (2nd ed., pp. 621-632). Amsterdam: Elsevier. Kaufmann, F., Kalbfleisch, M. L., & Castellanos, F. X. (2000). Attention deficit disorders and gifted students: What do we really know? Storrs, CT: National Research Center on the Gifted and Talented, University of Connecticut. Leroux, J.A., & Levitt-Perlman, M. (2000). The gifted child with attention deficit disorder: An identification and intervention challenge. Roeper Review, 22, 171-176. Moon, S.M., Zentall, S.S., Grskovic, J.A., Hall, A. & Stormont, M. (2001). Emotional, social, and family characteristics of boys with AD/HD and giftedness: A comparative case study. Journal for the Education of the Gifted, 24, 207-247. Moon, S. (2002). Gifted children with attention deficit/hyperactivity disorder. In M. Neihart, S. Reis, N. Robinson, S. Moon (Eds.). The social and emotional development of gifted children: What do we know? (pp. 193-204). Waco, TX: Prufrock Press. National Institutes of Health (1998). Diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) consensus statement. Washington, DC: Author. Neihart, M., Reis, S., Robinson, N., & Moon, S. (Eds.) (2002). The social and emotional development of gifted children: What do we know? Waco, TX: Prufrock Press. Olenchak, R., & Reis, S. (2002). Gifted children with learning disabilities. In M. Neihart, S. Reis, N. Robinson, & S. Moon (Eds.), The social and emotional development of gifted children: What do we know? (pp. 177-192). Waco, TX: Prufrock Press. Olenchak, F.R. (1994). Talent development: Accommodating the social and emotional needs of secondary gifted/learning-disabled students. Journal of Secondary Gifted Education, 5, 40-52. Reis, S.M., McGuire, J.M. & Neu, T.W. (2000). Compensation strategies used by high-ability students with learning disabilities who succeed in college. Gifted Child Quarterly, 44, 123-134.

Webb. J.T. (2001). Mis-diagnosis and dual diagnosis of gifted children: Gifted and LD, ADHD, OCD, oppositional defiant disorder. N. Hafenstein & F. Rainey (Eds.), Perspectives in gifted education: Twice exceptional children (pp. 23-31). Denver: Ricks Center for Gifted Children, University of Denver. Zentall, S.S., Moon, S.M., Hall, A.M., & Grskovic, J.A. (2001). Learning and motivational characteristics of boys with AD/HD and/or giftedness. Exceptional Children, 67, 499-519. Maureen Neihart, Psy.D. is a licensed clinical child psychologist in Billings, MT. ERIC Digests are in the public domain and may be freely reproduced and disseminated, but please acknowledge your source. This digest was prepared with funding from the Institute of Education Sciences (IES), U.S. Department of Education, under Contract No. ED-99-CO-0026. The opinions expressed in this publication do not necessarily reflect the positions or policies of IES or the Department of Education.

Before Referring a Gifted Child for ADD/ADHD Evaluation

Parents and gifted educators are asked with increased frequency to instruct gifted children to conform to a set of societal standards of acceptable behavior and achievement — to smooth the edges of the square peg in order to fit into a ―normal‖ hole. Spontaneity, inquisitiveness, imagination, boundless enthusiasm, and emotionality are being discouraged to create calmer, quieter, more controlled environments in school. An extension of this trend is reflected in an increase in referrals for medical evaluation of gifted children as ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder). There is no doubt that gifted children can be ADD/ADHD. However, there are also gifted children whose ―inappropriate behavior‖ may be a result of being highly gifted and/or intense. This intensity coupled with classroom environments and curriculum which do not meet needs of gifted, divergent, creative, or random learners, may lead to the mislabeling of many children as ADHD. To avoid mislabeling gifted children, parents and educators may want to complete the following check list to help them decide to refer for medical or psychological evaluation.

Gifted?

Need More Information

ADD/ADHD?

Contact with intellectual peers diminishes inappropriate behavior



Contact with intellectual peers has no positive effect on behavior

Appropriate academic placement diminishes inappropriate behavior



Appropriate academic placement has no positive effect on behavior

Curricular modifications diminish inappropriate behaviors



Curricular modifications have no effect on behavior

The child has logical (to the child) explanations for inappropriate behavior



Child cannot explain inappropriate behavior

When active, child enjoys the movement and does not feel out of control



Child feels out of control

Learning appropriate social skills has decreased “impulsive” or inappropriate behavior



Learning appropriate social skills has not decreased “impulsive” or inappropriate behavior

Child has logical (to the child) explanations why



Child is unable to explain why tasks, activities are not completed

Child displays fewer inappropriate behaviors when interested in subject matter or project



Child’s behaviors not influenced by his/her interest in the activity

Child displays fewer inappropriate behaviors when subject matter or project seems relevant or meaningful to the child



Child’s behaviors do not diminish when subject matter or project seems relevant or meaningful to the child

Child attributes excessive talking or interruptions on need to share information, need to show that he/she knows the answer, or need to solve a problem immediately



Child cannot attribute excessive talking or interruptions to a need to learn or share information

Child who seems inattentive can repeat instructions



Child who seems inattentive is unable to repeat instructions

Child thrives on working on multiple tasks – gets more done, enjoys learning more



Child moves from task to task for no apparent reason

Inappropriate behaviors are not persistent – seem to be a function of subject matter



Inappropriate behaviors persist regardless of subject matter

Inappropriate behaviors are not persistent – seem to be a function of teacher or instructional style



Inappropriate behaviors persist regardless of teacher or instructional style

Child acts out to get teacher attention



Child acts out regardless of attention

If, after addressing these questions, parents and teachers believe that it is not an unsuitable, inflexible, or unreceptive educational environment which is causing the child to ―misbehave‖ or ―tune out,‖ or if the child feels out of control, then it is most certainly appropriate to refer a gifted child for ADD/ADHD diagnosis. Premature referral bypasses the educational system and takes control away from students, parents and educators. By referring before trying to adjust the educational environment and curriculum, educators appear to be denouncing the positive attributes of giftedness and/or to be blaming the victim of an inappropriate educational system. When deciding to refer, parents should search for a competent diagnostician who has experience with both giftedness and attention deficit disorders. It is never appropriate for teachers, parents or pediatricians to label a child as ADD or ADHD without comprehensive clinical evaluation that can distinguish ADD/ADHD from look-alike with other causes. ADHD and Children Who Are Gifted

Howard’s teachers say he just isn’t working up to his ability. He doesn’t finish his assignments, or just puts down answers without showing his work; his handwriting and spelling are poor. He sits and fidgets in class, talks to others, and often disrupts class by interrupting others. He used to shout out the answers to the teachers’ questions (they were usually right), but now he day-dreams a lot and seems distracted. Does Howard have Attention Deficit Hyperactivity Disorder (ADHD), is he gifted, or both? Frequently, bright children have been referred to psychologists or pediatricians because they exhibited certain behaviors (e.g., restlessness, inattention, impulsivity, high activity level, daydreaming) commonly associated with a diagnosis of ADHD. Formally, the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) (American Psychiatric Association) lists 14 characteristics that may be found in children diagnosed as having ADHD. At least 8 of these characteristics must be present, the onset must be before age 7, and they must be present for at least six months. DSM-III-R Diagnostic Criteria for Attention-Deficit Hyperactivity Disorder* 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Often fidgets with hands or feet or squirms in seat (in adolescents may be limited to subjective feelings of restlessness). Has difficulty remaining seated when required to. Is easily distracted by extraneous stimuli. Has difficulty awaiting turns in games or groups situations. Often blurts out answers to questions before they have been completed. Has difficulty following through on instructions from others (not due to oppositional behavior or failure of comprehension). Has difficulty sustaining attention in tasks or play activities. Often shifts from one uncompleted activity to another. Has difficulty playing quietly. Often talks excessively. Often interrupts or intrudes on others, e.g., butts into other people’s games. Often does not seem to listen to what is being said to him or her.

13. Often loses things necessary for tasks or activities at school or at home (e.g., toys, pencils, books). 14. Often engages in physically dangerous activities without considering possible consequences (not for the purpose of thrill-seeking), e.g., runs into street without looking.

Almost all of these behaviors, however, might be found in bright, talented, creative, gifted children. Until now, little attention has been given to the similarities and differences between the two groups, thus raising the potential for misidentification in both areas — giftedness and ADHD. Sometimes, professionals have diagnosed ADHD by simply listening to parent or teacher descriptions of the child’s behaviors along with a brief observation of the child. Other times, brief screening questionnaires are used, although these questionnaires only quantify the parents’ or teachers’ descriptions of the behaviors (Parker, 1992). Children who are fortunate enough to have a thorough physical evaluation (which includes screening for allergies and other metabolic disorders) and extensive psychological evaluations, which include assessment of intelligence, achievement, and emotional status, have a better chance of being accurately identified. A child may be gifted and have ADHD. Without a thorough professional evaluation, it is difficult to tell. How Can Parents or Teachers Distinguish Between ADHD and Giftedness? Seeing the difference between behaviors that are sometimes associated with giftedness but also characteristic of ADHD is not easy, as the following parallel lists show. Behaviors Associated with ADHD (Barkley, 1990) 1. 2. 3. 4. 5. 6.

Poorly sustained attention in almost all situations Diminished persistence on tasks not having immediate consequences Impulsivity, poor delay of gratification Impaired adherence to commands to regulate or inhibit behavior in social contexts More active, restless than normal children Difficulty adhering to rules and regulations

Behaviors Associated with Giftedness (Webb, 1993) 1. 2. 3. 4. 5. 6.

Poor attention, boredom, daydreaming in specific situations Low tolerance for persistence on tasks that seem irrelevant Judgment lags behind development of intellect Intensity may lead to power struggles with authorities High activity level; may need less sleep Questions rules, customs and traditions

Consider the Situation and Setting It is important to examine the situations in which a child’s behaviors are problematic. Gifted children typically do not exhibit problems in all situations. For example, they may be seen as ADHD-like by one classroom teacher, but not by another; or they may be seen as ADHD at school, but not by the scout leader or music teacher. Close examination of the troublesome situation generally reveals other factors which are prompting the problem behaviors. By contrast,

children with ADHD typically exhibit the problem behaviors in virtually all settings including at home and at school though the extent of their problem behaviors may fluctuate significantly from setting to setting (Barkley, 1990), depending largely on the structure of that situation. That is, the behaviors exist in all settings, but are more of a problem in some settings than in others. In the classroom, a gifted child’s perceived inability to stay on task is likely to be related to boredom, curriculum, mismatched learning style, or other environmental factors. Gifted children may spend from one-fourth to one-half of their regular classroom time waiting for others to catch up — even more if they are in a heterogeneously grouped class. Their specific level of academic achievement is often two to four grade levels above their actual grade placement. Such children often respond to non-challenging or slow-moving classroom situations by ―off-task‖ behavior, disruptions, or other attempts at self-amusement. This use of extra time is often the cause of the referral for an ADHD evaluation. Hyperactive is a word often used to describe gifted children as well as children with ADHD. As with attention span, children with ADHD have a high activity level, but this activity level is often found across situations (Barkley, 1990). A large proportion of gifted children are highly active too. As many as one-fourth may require less sleep; however, their activity is generally focused and directed (Clark, 1992; Webb, Meckstroth, & Tolan, 1982), in contrast to the behavior of children with ADHD. The intensity of gifted children’s concentration often permits them to spend long periods of time and much energy focusing on whatever truly interests them. Their specific interests may not coincide, however, with the desires and expectations of teachers or parents. While the child who is hyperactive has a very brief attention span in virtually every situation (usually except for television or computer games), children who are gifted can concentrate comfortably for long periods on tasks that interest them, and do not require immediate completion of those tasks or immediate consequences. The activities of children with ADHD tend to be both continual and random; the gifted child’s activity usually is episodic and directed to specific goals. While difficulties and adherence to rules and regulations has only begun to be accepted as a sign of ADHD (Barkley, 1990), gifted children may actively question rules, customs and traditions, sometimes creating complex rules which they expect others to respect or obey. Some engage in power struggles. These behaviors can cause discomfort for parents, teachers, and peers. One characteristic of ADHD that does not have a counterpart in children who are gifted is variability of task performance. In almost every setting, children with ADHD tend to be highly inconsistent in the quality of their performance (i.e., grades, chores) and the amount of time used to accomplish tasks (Barkley, 1990). Children who are gifted routinely maintain consistent efforts and high grades in classes when they like the teacher and are intellectually challenged, although they may resist some aspects of the work, particularly repetition of tasks perceived as dull. Some gifted children may become intensely focused and determined (an aspect of their intensity) to produce a product that meets their self-imposed standards.

What Teachers and Parents Can Do Determining whether a child has ADHD can be particularly difficult when that child is also gifted. The use of many instruments, including intelligence tests administered by qualified professionals, achievement and personality tests, as well as parent and teacher rating scales, can help the professional determine the subtle differences between ADHD and giftedness. Individual evaluation allows the professional to establish maximum rapport with the child to get the best effort on the tests. Since the test situation is constant, it is possible to make better comparisons among children. Portions of the intellectual and achievement tests will reveal attention problems or learning disabilities, whereas personality tests are designed to show whether emotional problems (e.g., depression or anxiety) could be causing the problem behaviors. Evaluation should be followed by appropriate curricular and instructional modifications that account for advanced knowledge, diverse learning styles, and various types of intelligence. Careful consideration and appropriate professional evaluation are necessary before concluding that bright, creative, intense youngsters like Howard have ADHD. Consider the characteristics of the gifted/talented child and the child’s situation. Do not hesitate to raise the possibility of giftedness with any professional who is evaluating the child for ADHD; however, do not be surprised if the professional has had little training in recognizing the characteristics of gifted/talented children (Webb, 1993). It is important to make the correct diagnosis, and parents and teachers may need to provide information to others since giftedness is often neglected in professional development programs. *Note: ―DSM-III-R Diagnostic Criteria For Attention-Deficit Hyperactivity Disorder‖ reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, Washington, DC, American Psychiatric Association, 1987. References American Psychiatric Association (1987). Diagnostic and statistical manual of mental disorders, Third edition, revised. Washington, DC: Author. Barkley, R. A. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Press: New York. Clark, B. (1992). Growing up gifted. Macmillan: New York. Parker, H. C. (1992). The ADD hyperactivity handbook for schools. Plantation, FL: Impact Publications. Webb, J. T. (1993). ―Nurturing social-emotional development of gifted children.‖ In K. A. Heller, F. J. Monks, and A. H. Passow (Eds.), International Handbook for Research on Giftedness and Talent, pp. 525-538. Oxford: Pergamon Press. Webb, J. T., Meckstroth, E. A., and Tolan, S. S. (1982). Guiding the gifted child: A practical source for parents and teachers. Dayton: Ohio Psychology Press. This ERIC Digest was developed in 1993 by James T. Webb, Ph.D., Professor and Associate Dean, and Diane Latimer, M.A., School of Professional Psychology, Wright State University, Dayton, Ohio. ERIC Digests are in the public domain and may be freely reproduced and disseminated, but please acknowledge your source. This publication was prepared with funding from the U.S.

Department of Education, Office of Educational Research and Improvement, under Contract No. RR93002005. The opinions expressed in this report do not necessarily reflect the positions or policies of OERI or the Department of Education. Tips for Parents: Parenting your Gifted Child with ADHD Printer Friendly Version Nicpon, M. Davidson Institute for Talent Development 2008 This Tips for Parents article is from a seminar hosted by Megan Foley Nicpon, Ph.D. She discusses parenting the gifted child with ADHD, touching on key issues such as: Psychological testing, medication, and behavioral and educational interventions to consider. Does my child have ADHD? According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR), a diagnosis of ADHD entails the following: 1. Six or more symptoms of inattention (fails to attend to details or makes careless mistakes; has difficulty sustaining attention in play or on tasks; does not seem to listen when spoken to; does not follow-through on instructions and fails to finish activities; has difficulty organizing tasks or activities; avoids, dislikes, or is reluctant to engage in activities requiring sustained attention or mental effort; often loses things necessary for task completion; is often distracted; and often is forgetful in daily activities) to a level that is maladaptive and inconsistent with development. 2. Six or more symptoms of hyperactivity/impulsivity (fidgets with hands or feet and squirms in seat; leaves seat in classroom when remaining seated is expected; runs about or climbs excessively in inappropriate situations; has difficulty playing quietly; is often on the go; talks excessively; blurts out answers before questions have been completed; has difficulty waiting his/her turn; and interrupts others) to a level that is maladaptive and inconsistent with development. 3. Symptoms causing impairment need to be present before age 7, and impairment (social, academic, or occupational) needs to be present in two or more settings. It is always important to remember that, for a diagnosis of ADHD, there needs to be a set of symptoms negatively affecting functioning – not just one or two. For example, because a child is able to hyperfocus (which, actually, is not a part of the diagnostic criteria), it does not necessarily mean that the child has ADHD, or is gifted. What is troublesome for a child with ADHD is controlling attention, particularly in situations that are not necessarily rewarding or require substantial effort. Hyperfocus can be a positive thing when it corresponds with task motivation, but it is troublesome when a child needs to shift his/her attention or focus on activities that are socially required (e.g., sitting at one’s seat completing schoolwork). Often, when people describe hyperfocus in children with ADHD, they are referring to the child who watches television or plays video games for hours. This typically is not the same way that hyperfocus is described in

gifted children, where a child works on a Lego set or reads about space for hours. While ADHD is considered to be a pervasive difficulty, the outcome varies depending on several issues, like intensity of the disorder, co-morbidity with other disorders, positive family environment, etc. Psychological Testing There are many reasons why a person is inattentive or forgetful, such as depression, stress, or anxiety. Therefore, a comprehensive evaluation is needed to definitively diagnose ADHD. One needs to know what is ―causing‖ the difficulty to effectively ―treat‖ the difficulty. In our practice at the Assessment and Counseling Clinic, the assessment battery varies depending on (1) the referral question and (2) how the testing data unfolds. All scores from psychological tests should be interpreted within a context. For example, there are a multitude of reasons why a student would demonstrate slower than expected processing. Therefore, when I see a difference in IQ scores such that the verbal and nonverbal scores are far superior to the processing speed score, I try to discern what could be causing the discrepancy. If I think that the difference is related to attention, I would look at scores on measures of executive functioning, continuous performance tests, and behavioral rating scales and see if there is a pattern. Typically, an ADHD assessment in our clinic consists of the following tests:       

Cognitive ability measure (e.g., WISC-IV, WAIS-III) Achievement measure to rule out a learning disability (e.g., WIAT-II or WJIII) Neuropsychological / executive functioning /memory measures (e.g., WMS, NEPSY-II attention battery or D-KEFS select subtests, Ray Complex Figure) Attention measure (e.g., CPT-II) ADHD rating scales (e.g., Brown ADD Scales – parent, teacher, and self; ADHD Rating Scale – parent, teacher) Psychosocial screener (e.g., BASC-2 parent, teacher, and self-report) Self-esteem measure (e.g., Piers-Harris, 2nd Edition)

Medications In general, researchers have found that psychopharmacological treatments for ADHD reduce the core symptoms of ADHD (inattention, hyperactivity, and impulsivity), and improve the child’s general ability to handle task demands and academic productivity. They have not been shown to help with learning and applying knowledge to various situations. Researchers have also found that behavioral treatments are helpful, but not as helpful as medications in reducing the core symptoms of ADHD. They are, however, just as effective at reducing oppositional and defiant behavior and improving parent-child relationships. Not everyone with a diagnosis of ADHD responds well to a psychostimulant medication treatment regimen. In fact, about 20% of individuals with ADHD/ADD do not respond positively to stimulants. However, one positive aspect to considering a trial of stimulant medication is that

they are quick in / quick out. Sometimes, it takes various trials before one finds a medication that works with minimal side-effects. Some children will need to take medications as they get older, but others will not. Behavioral and educational interventions to consider: All Students 1. Implement a reward system for trying and maintaining organizational tools, such as assignment notebooks. 2. Involve your child in establishing motivators for positive behaviors. We all benefit from motivators. I am a runner, and I love to run. But, I work full-time and have two kids. Time is limited and I am tired a lot, so exercise seems to be the first to go. So, I typically register for a few races each season to keep me motivated to get myself out there to run. It is a motivator for me because I am competitive and want to perform well. The key to a successful reward program is finding out what is motivating. 3. Point out the positive behaviors that are exhibited, and emphasize the benefits of studying and obtaining good grades. 4. Consider structuring unstructured time. Have your child work with an aide to establish goals for the unstructured time – e.g., what parts of my homework will I accomplish during this unstructured time? Having your child participate and make his/her own goals will be important. Have these written out so that he/she can see them during the time. 5. Let your child break up his/her homework time into smaller chunks where he/she is ―rewarded‖ with a 10 – 15 minute break after working for a set period. Of course, this system would need to be monitored initially, but hopefully with praise and positive results he/she would develop this method as a positive way to get his/her work done as he/she enters more independent environments (college or career). Sometimes setting a timer or having your child use a digital watch where he/she can self-monitor behavior helps regulate time on and off task. Older Students 1. Approach the use of an organizational tool as a very ―adult‖ thing to do, not something that is demeaning or for ―dumb‖ people. Consider having a professional talk to your son/daughter about how he/she uses organizational tools to his/her benefit. 2. Normalize organizational tools – they are not for ―stupid‖ people; rather, they can help ―de-clutter‖ the brain of gifted people to allow for more creative activity to take place. 3. For middle school and high school gifted students with ADHD, this is the age where students typically don’t want to appear ―different‖ or like they have any special needs. So, providing accommodations that are within a ―normal‖ environment will likely be the most successful. This is also a time where students seem to have increased pressure for social status, and sometimes academics can be negatively affected by this shift in attention and focus. Normalizing the need to be social while emphasizing the need for attention to school, and rewarding this behavior, would be helpful. 4. In college, sometimes there are tutors or coaches available through student disability services that help with organization and time management skills. Also I would suggest

that your child enroll in a class that addresses adjustment to college issues, if one is available. While not academically challenging, these courses teach necessary skills for successfully transitioning to the more independent college environment.

This article is provided as a service of the Davidson Institute for Talent Development, a 501(c)3 nonprofit dedicated to supporting profoundly gifted young people 18 and under. To learn more about the Davidson Institute’s programs, please visit www.DavidsonGifted.org.

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