Gifted and ADD/ADHD, OCD and Aspberger's

Dr. Amend has recently co-authored a book entitled Misdiagnosis and Dual Diagnosis of Gifted Children and Adults: ADHD, Bipolar, OCD, Asperger's Depression and Other Disorders, which addresses many of the issues gifted children, adults and their families face. In this interview, he discusses many of the current concerns faced by parents, teachers and counselors who work with gifted children have. 1. What are some ways to distinguish between gifted behaviors and pathological behaviors? One of the most important pieces of information is the context in which the behaviors are shown. Let me be clear that pathological behaviors are not necessarily characteristic of gifted children and adults; however, some behaviors that may appear pathological in certain contexts can be better explained by giftedness than by any pathology. For example, inattention can be indicative of an Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type, and inattention would not be considered a "characteristic" of giftedness. However, inattention and concentration difficulties can also be caused by a number of factors including depression or anxiety. Inattention may also be explained by lack of interest, an inappropriate curriculum (curriculum not meeting a gifted child's needs), or a variety of other factors. Viewing this inattention in the context of the person and the environment will better enable a clinician to determine the appropriate cause of the behavior and to determine whether the inattention would be better addressed by curriculum modifications, therapy, or medication, for example. 2. What are some characteristics of gifted children and adults? If you pick up just about any book on gifted children, you will find a list of typical characteristics of gifted children. These lists typically include things like strong memory, large vocabulary, persistence, and a wide range of interests. Gifted children typically learn to read earlier than other children and show an intensity that cuts across all interests and activities. These characteristics typically persist into adulthood. However, I believe that asynchronous or uneven development and the fact that gifted children really do see the world differently than others are two traits that truly differentiate a gifted person. Their superior intellectual abilities allow them to view the world from different perspectives, and as a result their behaviors are both qualitatively and quantitatively different from the norm. Whether their giftedness is in the intellectual domain, specific academic areas, creativity, or visual and performing arts, they typically show uneven development, intensity, and ability that far surpasses most others their age. Often, they demonstrate not only the potential to perform at high levels, but also a high level of performance. 3. How can we avoid mislabeling gifted children? It seems, today, that we are very quick to label any behavior that is different from the norm in any way as pathological. As a society, we have become very interested in the labels which can be placed upon individuals and their maladies. On the positive side, by accepting these differences and their labels, we become more accepting of the people who bring them and minimize the stigma historically associated with mental illness. However, the ease with which any difference is labeled is certainly of concern. Specifically, gifted children, by definition, are different in at least one way. When these innate differences are misunderstood and labeled as pathological, the gifted child's true needs are not met. Recognizing that the gifted child's needs arise from his or her strengths, rather than his or her weaknesses, can allow others to better address these needs. Providing appropriate curriculum and interventions to address these needs will promote adjustment among gifted children. Appropriately using giftedness as an explanation, but not an excuse, for any behaviors that may seem apart from the norm can also help. 4. What are the emotional needs of gifted children? There is a good bit of research looking at the social and emotional needs of gifted and talented children. As a group, gifted children are not necessarily more or less well adjusted than any other group. However, gifted children face risks that many other groups do not face. For example, their asynchronous or uneven development creates difficulties in relating to both themselves and others. Gifted children may be more likely to view themselves based on their relative weaknesses, even though these abilities may fall in the average range, rather than their strengths that are often well above average. As a group, gifted children show more perfectionist behaviors than other groups, and this creates potential difficulties. Finally, the lack of educational fit can also create adjustment or emotional difficulties. 5. Suicide is always a major concern. What should parents, teachers and counselors be on the look out for? While it is clear that some gifted children do commit suicide, it is impossible at this time to answer the question whether gifted children commit suicide more frequently than other children and teenagers. The data simply are not there. There are a number of specific factors that are associated with suicide, and we know that suicide is more frequent than everyone would like. Some of the risk factors for suicide include drug and alcohol abuse; family loss or disruption; family history of suicide, psychiatric disorders, or substance abuse; impulsiveness; adverse life events; easy access to lethal methods; and exposure to suicidal behavior of others, including friends or media portrayals (true or fiction). 6. Perfectionism seems to be a major issue. How can parents and teachers address this concern? It is clear that perfectionism is a major issue among gifted and talented children. Here are a few ideas for parents. Allowing children to make and learn from mistakes by using natural consequences can be helpful. Modeling appropriate handling of mistakes is also an important factor in the management of perfectionism. In addition, rewarding efforts and time invested in projects rather than solely the outcome can also help address perfectionism. Parents can work to convey the courage to try, encourage appropriate risk-taking, help children remove "should" and "ought" from their vocabulary, and occasionally give children permission to be messy, late, or incomplete. Discuss both strengths and weaknesses when reviewing individual differences, and find positive outlets for perfectionism because perfectionism channeled appropriately can be a positive force in one's life. While there is no one way to address this issue, there are also several books available that can help. Perfectionism: What's Bad about Being Too Good is a personal favorite. 7. On the other hand, some gifted children's handwriting and work is sloppy, rushed and pushed or hurried. How can teachers address this issue? This is certainly a difficult issue. It is important that gifted children be given opportunities to demonstrate their strengths. Their strengths should never be at the mercy of their weaknesses. if weaknesses in handwriting exist, gifted children should be provided with opportunities to demonstrate their strengths without the impact of these weaknesses. For example, oral tests and oral reports can be useful as well as shortened assignments that allow the child to show mastery. These interventions are relatively easy to implement, and can decrease frustration while allowing gifted children to demonstrate the full extent of their skills without the impact of the weakened handwriting. It is also true that gifted children can be "twice-exceptional," being both gifted and having a learning disability in an area such as written expression. In these cases, additional interventions may be necessary. Keyboarding skills, hand held tape recorders, and/or scribes may be necessary. In all cases, it is important to focus on the child's strengths, develop persistence, and foster achievement in ways that minimize the impact of the weaknesses. 8. How do teachers assign "appropriate" level work to challenge and stimulate? Before one can assign an "appropriate" level work, it is important to find what that truly is. In my experience, pre-testing is a most valuable tool in identifying a gifted child's skills. Utilizing pre-testing liberally can help teachers discover what a child already knows. By learning what a child knows, teachers are then better able to differentiate assignments in order to challenge and stimulate gifted learners. Incorporating a gifted child's interest into any independent projects can also help motivation. 9. How do educational needs of a gifted learner differ from those of the non-gifted learner? Gifted children learn more quickly and think more deeply than typical children. Their intellectual abilities differ both qualitatively and quantitatively from the average student. As a result, they will need opportunities to delve more deeply into topics. They also need less repetition to master material and shortening assignments can be helpful. Gifted children need higher level materials presented at a faster pace in order to achieve. By all means, raise the bar! 10. What are the most common diagnosis given to gifted children and adults? Most frequently, my colleagues and I see diagnoses of Attention-Deficit/Hyperactivity Disorder and Asperger's Disorder diagnoses given to gifted children. Of course, these diagnoses are accurate in some cases,. In many others, however, we see that the typical characteristics of gifted children are misconstrued or misinterpreted to represent pathology. In these cases, diagnosis such as Attention-Deficit/Hyperactivity Disorder is misdiagnosed. That is, the behaviors being seen can be better explained by giftedness and better addressed by interventions targeted toward the giftedness rather than the pathological condition of Attention-Deficit/Hyperactivity Disorder. Recently, we have also begun seeing an increase in the diagnosis of Juvenile Bipolar Disorder. It is important to note that there is much controversy about this diagnostic entity, and no specific criteria for its diagnosis have been set by the American Psychiatric Association or the American Psychological Association. As a result of this inconsistency and lack of clarity, we believe many gifted children are being misdiagnosed with Juvenile Bipolar Disorder. Again, this occurs when typical characteristics of gifted children are misconstrued to indicate pathology. 11. What advice can you give parents for ways to select a counselor or health care professional? When parents of gifted children are looking for a counselor or health care professional to address their gifted child's needs, it is important to find someone with a background in giftedness. This is important not only because of the issue of misdiagnosis, but also because of the importance of interventions to address giftedness. Often, parents will seek help from psychologists who have little experience in giftedness, and many are dissatisfied with the result because the majority of health care professionals receive no training regarding the special needs of gifted and talented children. To emphasize this point, I can say that having conducted this interview, you now have more information about the needs of gifted and talented children than the typical mental health or health care professional receives during training. Toward the end of finding qualified health care professionals, Supporting the Emotional Needs of the Gifted (SENG) has created a continuing education course for psychologists in order to help educate them regarding the needs of gifted and talented children. In addition, SENG has created a Professional Advisory Committee of health care professionals in order to find further ways to educate. SENG has also published a brochure entitled "Selecting a Psychologist or Psychiatrist for Your Gifted Child. This brochure is available for download or purchase in bulk at [url]www.sengifted.org[/url] . This brochure contains some information for parents as well as specific questions they may wish to ask a potential mental health professional regarding their experience with gifted and talented children. I cannot stress enough the importance of finding a health care professional with some background in gifted and talented children. 12. What question have we neglected to ask? I think it is important to note that meeting the educational needs of the gifted and talented child will also help their social and emotional adjustment. The research has been fairly clear in suggesting that the degree to which a gifted child's educational needs are being met is an important factor in their overall adjustment. Another important issue is the frequency of misdiagnosis. Often we are asked, "How frequent is the misdiagnosis of gifted and talented children?" At this point, we do not know how frequently gifted children are misdiagnosed, but we do know that it happens. Our clinical experience tells us that it happens often. Much more research is needed to assess these issues. The book Misdiagnosis and Dual Diagnosis of Gifted Children and Adults written by several colleagues and me discusses in much more depth these issues of misdiagnosis. Finally, I think it is important to mention more clearly that some gifted children do have other difficulties such as an attention disorder, Asperger's Disorder, or a learning disability. These so-called twice exceptional or multi-exceptional children have additional needs that must be addressed. The gifted child with a learning disability has some abilities that are often well above average and others that are below average at the same time. These needs are much more difficult to address, and gifted children with a dual-diagnosis or twice-exceptionality will need special care and interventions to address both their strengths and weaknesses simultaneously. This is a difficult challenge, indeed.