Gifted Resource Center of New England: Misperceptions About Giftedness Diagnosis of ADHD and Other Disorders
by Deirdre V. Lovecky, Ph.D.
“This article was written as an attempt to counter various misconceptions about gifted children, and the likelihood of being diagnosed with a mental health disorder. There is a lot of information passed on through books, journal articles, websites and conferences that can lead to misconceptions. Parents, teachers and mental health professionals have no way of knowing which information is based on research, and which is based on opinion and supposition.
This article reviews some of the research about gifted children and mental health disorders. There are three main issues:
The Issue of Misdiagnosis: Are gifted children being misdiagnosed as having mental disorders like ADHD when they do not?
The Issue of Prevalence: What is the likelihood of a gifted child having a mental disorder like ADHD?
The Issue of Maladjustment: Are gifted children more prone to having particular mental disorders than the average population?
1. The Issue of Misdiagnosis:
To answer the question about whether gifted children are being misdiagnosed, it is important to examine the actual research data available about gifted children and mental health disorders. For almost 100 years, since Terman’s (1925) famous study of 1000 gifted children followed throughout their lifetimes, researchers have found gifted children, in general, to be above average in social and emotional adjustment, as well as advanced in academic areas, such as reading and math. Gifted children studied by Gottfried et al. (1994) in the Fullerton Longitudinal Study, were found to show early intrinsic motivation, superiority in attention, persistence, curiosity, enjoyment of learning and desire for mastery and challenge. This holds true for the vast majority of gifted children. As IQ increases, however, there is some evidence that social and emotional adjustment is more difficult, and a lower percentage of these children (above IQ 160) were found to be well adjusted. Hollingworth (1942), in her studies of exceptionally gifted children over 180 IQ, described an optimal level of intelligence, between 120-145, where gifted children were not so different from age peers that they did not fit in. These are generally the children, in fact, chosen as leaders by their more average age peers. In the higher IQ ranges though (160+), gifted children experience enough difference from age peers that they do not fit in with age peers. These children can show less optimal social and emotional adjustment (Hollingworth, 1942). Janos (1983, cited in Janos & Robinson 1985) found that the percentage of highly gifted children (IQ 160+) having psychosocial difficulties was 21%.
While research on gifted children indicates better than average social and emotional adjustment for the vast majority, there is a contingent of writers in the field of gifted psychology who contend that gifted children, in general, have traits that look like those of various mental disorders. Webb et al. (2006) state that: Many gifted and talented children (and adults) are being mis-diagnosed by psychologists, psychiatrists, pediatricians, and other health care professionals. The most common mis-diagnoses are: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (OD), 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 social and emotional characteristics of gifted children, which are then mistakenly assumed, by these professionals to be signs of pathology (p. 1).
Is this true? Do gifted children in general have behavioral and emotional traits that look like symptoms of mental disorders? What is the research that supports this contention? A number of authors suggest, but have no research data to support their contentions, that gifted children are being misdiagnosed, particularly with ADHD (Baum & Olenchak, 2002; Groess et al., 2006; Harnett, Nelson & Rinn, 2004; Nelson, Rinn & Harnett, 2006; Webb et al., 2005, among others).
First of all, there are no research studies in the literature that have examined how frequent misdiagnosis is, or if it actually occurs at all. ADHD is the misdiagnosis most often mentioned in published writings in the field of gifted children; yet, no one has done a research study that showed that gifted children are commonly misdiagnosed with ADHD.
Webb and Latimer (1993), in an article that has been widely quoted in the literature, listed the symptoms of ADHD from the DSM-III-R (American Psychiatric Association, 1987) and stated, “almost all of these behaviors, however, might be found in bright, talented, creative, gifted children (Webb & Latimer, 1993, p.2).” They go on to list behaviors that they state are common to gifted children that can be mistaken for ADHD. They have two lists: one compiled from Barkley (1990), and one Webb composed (Webb, 1993, cited in Webb and Latimer 1993). On close examination, the lists are not identical. For example, Webb and Latimer list as Barkley’s (1990) description of ADHD behaviors, “Impulsivity, poor delay of gratification.” The comparable behavior that might be mistaken for impulsivity is “Judgment lags behind development of intellect” (Webb, 1993, listed in Webb and Latimer 1993). Less mature judgment than one’s level of intellect does not mean the judgment is impulsive, that is, acting without thinking. For example, a gifted child might not weigh the same factors in making a decision as a person of their mental age due to a lack of experience, but the decision would not be at all impulsive.
What is the research evidence that the ADHD symptoms listed in Webb and Latimer (1993) as common to gifted children are really found in gifted children?
If a child has ADHD, it would be expected that the child would exhibit inattention, impulsivity, distractibility and hyperactivity to varying degrees depending on the type of ADHD. These are symptoms listed in DSM-III-R and DSM-5 (American Psychiatric Association, 1987; 2013) as symptoms of ADHD. Children with ADHD also exhibit deficits in executive functions (Barkley, 1997; Brown, 2000). The executive functions are those aspects of performance that allow for learning and doing. For example, focusing and shifting attention, planning tasks, getting started on tasks, sustaining effort, completing tasks and managing obstacles and frustration are all executive functions.
Since writers such as Webb et al. (2005); Webb, Gallagher & Kuzujanakis, (2012) and others list the symptoms of ADHD as common among gifted children, we would expect that tests that specifically measure these behaviors (inattention, hyperactivity, impulsivity, etc.), as well as executive functions, would make gifted children without ADHD look like average children with ADHD. That is, gifted children without ADHD would score higher in impulsivity, inattention, distractibility, and hyperactivity than average children without ADHD, who, of course, would not have measureable symptoms of ADHD.
Research studies of gifted children without ADHD have shown their ability to self-regulate and concentrate (the opposite of impulsivity and inattention) to be superior to that of average children without ADHD (Calero et al., 2007), that is, they were more attentive and less impulsive. Gifted children were superior to average children in mental attention capacity, cognitive inhibition (the opposite of impulsivity) and speed of processing (Johnson et al., 2003). On tests of executive functions, gifted children without ADHD showed superior ability when compared to average children without ADHD (Arffa, 2007). The gifted children scored like older children on executive function skills. For example, on a test of learning the underlying principle of how to sort cards, gifted children were superior to average children (Tanabe et al., 2012). Thus, gifted children without ADHD do not show the deficits in attention, inhibition, distractibility, performance speed or executive functions that are shown by children with ADHD, and these are not traits of giftedness.
Studies of gifted children with ADHD compared to gifted children without ADHD have shown that gifted children with ADHD score lower than gifted peers without ADHD on FSIQ, Working Memory and Processing Speed on the Wechsler Intelligence Scale for Children, as well as on tasks of inhibition. Thus the gifted children with ADHD scored lower on tasks that measure attention, speed, and ability to inhibit responding (Radisavljevic 2011). On tasks of executive functioning, such as planning and organization (Dillon et al., 2013), and verbal memory (Hanratty, 2013), when gifted children with ADHD are compared to average children with ADHD, both groups show deficits on tests of executive function, attention, distractibility, and impulsivity as expected, but gifted children had higher scores than average children with ADHD (Chae et al., 2003; Mahone et al., 2002; Radisavljevic et al., 2009). The higher scores of gifted children with ADHD were not as high as those of gifted children without ADHD, but were higher than the scores of average children with ADHD. For some tasks the scores of gifted children with ADHD were average. Higher scores, in the average range, can lead unaware clinicians to conclude that gifted children do not have executive function deficits and attention problems when, in fact, they do. It is the discrepancy between their potential and how they perform on the attention, inhibition and executive function tasks that matters. The gap between an IQ of 130 and average performance (SS 100) is larger than the gap required for diagnosis for average children (FSIQ 100 vs. SS 80), and can be as impairing.
Others have found that ADHD in both gifted children and adults to be persistent and problematic (Antshel, 2008; Antshel et al., 2007; Katusic et al., 2011). There is little reason to think that traits of ADHD are common in gifted children without ADHD, or that ADHD is being misdiagnosed in gifted children.”
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