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Twice exceptional (2e): Gifted with ADD/ADHD, Part 2

March 19, 2013

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In our November issue of the Gifted Matters Newsletter, we discussed the issue of misdiagnosis of ADD/ADHD when the behavior could instead be attributed to common characteristics of gifted children (click here to read that article).  In Part 2, learn about the criteria for ADD/ADHD diagnosis as well as the characteristics that distinguish gifted/ADD/ADHD students from others.

Diagnosis of ADD/ADHD on the rise

A diagnosis of ADD/ADHD has become increasingly common according to the Centers for Disease Control and Prevention (CDC). According to a survey conducted by the CDC, “The percentage of children with a parent-reported ADHD diagnosis increased by 22% between 2003 and 2007.” Currently, 8.4% of children age 3-17 years have been diagnosed with ADHD.

  • 12.0% of boys (3-17 yrs) have been diagnosed with ADHD
  • 4.7% of girls (3-17 yrs) have been diagnosed with ADHD.

Are these children correctly diagnosed? In 2012, the CDC released data from a multistate study (Project to Learn about ADHD in Youth “PLAY“) on the diagnosis and treatment of ADHD. The results found that many children who were taking ADHD medication did not meet the definition of ADHD (specifically, only 39.5% in one state and 28.3% in another state met the case definition). While the CDC does not address whether these children were misdiagnosed originally, the point is clear that a majority of the children studied should not have been on the medication for ADD/ADHD.

There is no indication that the diagnosis of ADD/ADHD will decline.  In fact, many experts have voiced concern about further broad criteria in the DSM-V, to be released in May 2013 by the American Psychiatric Association.  Click here for more information.  A summary of the criteria is provided below.  It is easy to comprehend why so many students and adults are diagnosed with ADD/ADHD and why there is a likelihood of misdiagnosis based on these extensive diagnositic standards.

DSM-V
ADHD: Inattention
(6 or more in children, 4 or more in adults)
ADHD: Hyperactivity
(6 or more in children, 4 or more in adults)
Fails to give close attention to details Fidgets
Difficulty sustaining attention Restless
Does not seem to listen Runs about
Does not follow through Excessively loud
Difficulty organizing tasks “on the go”
Reluctant to engage in tasks that require sustained mental effort Talks excessively
Loses objects Blurts out an answer
Easily distracted Difficulty waiting his or her turn
Forgetful Interrupts or intrudes
Acts without thinking
Impatient
Uncomfortable doing things slowly and systematically
Difficult to resist temptation

.

Diagnosis of ADD/ADHD in gifted children

Before your child is diagnosed, ensure that your specialist is going to look at the whole child. If you think your child might be gifted, consider someone who is an expert in giftedness and ADD/ADHD.  Additionally, the person conducting the evaluation should look to the child’s true peers when assessing the appropriateness of their developmental level.

“In assessing ADHD, gifted children need to be compared to gifted peers in a stimulating environment rather than average children in regular classes”  – Deirdre Lovecky, in Different Minds

Dual Diagnosis of ADD/ADHD and Gifted

bookcover210x315There are, of course, children who are correctly assessed as both ADD/ADHD and gifted. Deirdre Lovecky, in her book, Different Minds, outlines some of the differences between students who are twice exceptional (2e) and their peers.

Gifted children with ADHD are different from average children with ADHD

  • On testing, miss many easier items and are correct on the more difficult ones
  • Typically have a greater degree of asynchrony
  • More sensitive and intense
  • Require more complexity in activities, interests and friendships

Gifted children with ADHD are different from typical gifted children

  • Greater degree of asynchrony
  • Cognitive deficits related to working memory and inductive reasoning
  • Unable to focus on tasks; complete less work than typical gifted child
  • More difficulty in self-control and self-monitoring of behavior
  • Difficulty inhibiting action

If your child is gifted, Lovecky offers the following suggestions to determine whether your child might also suffer from ADD/ADHD:

  • Changing school environment doesn’t help
  • Children are unable to focus on a variety of activities
  • Behavior is not just a school problem
  • Needs additional interventions when compared to gifted peers

Intervention and treatment of ADD/ADHD in gifted children

Lovecky urges those working with twice exceptional children to seek expertise in both giftedness and ADHD to meet these unique needs.  “School programs need to consider both strengths and weaknesses, and work to provide environments that maximize stimulation and interest at the appropriate level for children. This is because gifted children with ADHD have underlying deficits in executive functions that require intervention, but accommodations needed will be different from those recommended for more average children with ADHD.”

Misdiagnosis of children with ADD/ADHD and giftedness

misdiagnosis“[Many experts on giftedness] are of the opinion that gifted children are incorrectly diagnosed as suffering from ADD/ADHD particularly often.” – Dr. James T. Webb, in Misdiagnosis and Dual Diagnosis of Gifted Children and Adults.

Why the confusion specifically regarding giftedness and ADD/ADHD? The line between gifted and ADD/ADHD can be very blurred.

From Misdiagnosis and Dual Diagnosis of Gifted Children and Adults
ADD/ADHD Giftedness
Poorly sustained attention in almost all situations Poor attention, boredom, daydreaming in specific situations
Diminished persistence on tasks not having immediate consequences Low tolerance for persistence on tasks that seem irrelevant
Impulsivity, poor ability to delay gratification Judgment lags behind intellect
Impaired adherence to commands to regulate or inhibit behavior in social contexts Intensity may lead to power struggles with authorities
More active, restless than normal children High activity levels; may need less sleep
Difficulty adhering to rules and regulations Questions rules, customs, and traditions

For more information on misdiagnosis, please refer to Part 1 by clicking here.

One Comment leave one →
  1. overexcitable permalink
    December 8, 2013 5:30 pm

    I’ve read, reread and loved the book “Misdiagnosis and Dual Diagnoses…”, as well as pretty much everything I can find online about the combination of giftedness and ADHD. Dr. James Webb, for one, seems to be very knowledgeable about giftedness, like Dr. Russel Barkley is in the field of ADHD, but I still have not found any expert on the combination?

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