Mis-Diagnosis and Dual Diagnosis of Gifted Children:
Gifted and LD, ADHD, OCD, Oppositional Defiant Disorder
James T. Webb, Ph.D.
gifted and talented children (and adults) are being mis-diagnosed by
psychologists, psychiatrists, pediatricians, and other health care
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,
Dysthyinic Disorder, Depression, and Bi-Polar Disorder.
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
example, existential depression or learning disability, when present in
gifted children or adults, requires a different approach because new
dimensions are added by the giftedness component.
the giftedness component typically is overlooked due to the lack of
training and understanding by health care professionals (Webb &
internal and situational factors can lead to interpersonal and
psychological difficulties for gifted children, and subsequently to
mis-diagnoses and inadequate treatment.
less attention has been given to the observation that these personality
factors intensify and have greater life effects when intelligence level
increases beyond JQ 130 (Silverman, 1993; Webb, 1993; Winner, 2000).
children -- and gifted adults-- often are extremely intense, whether in
their emotional response, intellectual pursuits, sibling rivalry, or
power struggles with an authority figure.
these characteristics together result in an intense idealism and
concern with social and moral issues, which can create anxiety,
depression, and a sharp challenging of others who do not share their
fact, we generally value these characteristics and behaviors--unless
they happen 10 occur in a tightly structured classroom, or in a highly
organized business setting, or if they happen to challenge some
cherished tradition, and gifted children are the very ones who
challenge traditions or the status quo.
relations for gifted children are often difficult (Webb, Meckstroth and
Tolan, 1982; Winner, 2000), all the more so because of the internal
dyssynchrony (asynchronous development) shown by so many gifted
children where their development is uneven across various academic,
social, and developmental areas, and where their judgment often lags
behind their intellect.
gifted children surely do suffer from ADHD, and thus have a dual
diagnosis of gifted and ADHD; but in my opinion, most are not. Few
health care professionals give sufficient attention to the words about
ADHD in DSM-IV( 1994) that say "...inconsistent with developmental
gifted child's developmental level is different (asynchronous) when
compared to other children, and health care professionals need to ask
whether the child's inattentiveness or impulsivity behaviors occur only
in some situations but not in others (e.g., at school but not at home;
at church, but not at scouts, etc.).
problem behaviors are situational only, the child is likely not
suffering from ADHD.
(1993) has suggested that perhaps the same percentage also suffer from
allergies of various kinds. Physical reactions in these conditions,
when combined with the intensity and sensitivity, result in behaviors
that can mimic ADHD.
the ADHD-like symptoms in such cases will vary with the time of day,
length of time since last meal, type of foods eaten, or exposure to
other environmental agents.
struggles with parents and teachers are common, particularly when these
children receive criticism, as they often do, for some of the very
characteristics that make them gifted (e.g., why are you so sensitive,
always questioning me, trying to do things a different way, etc.).
adolescence, or sometimes earlier, gifted children often do go through
periods of depression related to their disappointed idealism, and their
feelings of aloneness and alienation culminate in an existential
depression. However, it is not at all clear that this kind of
depression warrants such a major diagnosis.
gifted first graders are seen as perfectionist and "bossy" because they
try to organize the other children, and sometimes even try to organize
their family or the teacher. As they grow up, they continue to search
intensely for the "rules of life" and for consistency.
intellectualizing, sense of urgency, perfectionism, idealism, and
intolerance for mistakes may be misunderstood to be signs of
Obsessive-Compulsive Disorder or Obsessive-Compulsive Personality
some sense, however, giftedness is a dual diagnosis with
Obsessive-Compulsive Personality Disorder since intellectualization may
be assumed to underlie many of the DSM-IV diagnostic criteria for this
psychologists are aware that inter-subscale scatter on the Wechsler
intelligence tests increases as a child's overall IQ score exceeds 130.
In children with a Full Scale IQ score or greater, it is not uncommon
to find a difference of 20 or more points between Verbal IQ Performance
IQ (Silverman, 1993; Webb & Kleme, 1993; Winner, 2000).
clinical psychologists are taught that such a discrepancy is serious
cause for concern regarding possible serious brain dysfunction,
including learning disabilities.
highly gifted children, such discrepancy is far less likely to be an
indication of pathological brain dysfunction, though it certainly would
suggest an unusual learning style and perhaps a relative learning
Wechsler Intelligence Scale
for Children -III, it is not uncommon to find subscale differences
greater than seven scale score points for gifted children, particularly
those who are highly gifted.
score discrepancies are taken by
most psychologists to indicate learning disabilities, and in a
functional sense they do represent that.
is, the levels of ability
do vary dramatically, though the range may be "only" from Very Superior
to Average level of functioning. In this sense, gifted children may not
"qualify" for a diagnosis of learning disability, and indeed some
schools seem to have a policy of "only one label allowed per student,"
and since this student is gifted, he/she can not also be considered
it is important for psychologists to
understand the concept of "asynchronous development" (Silverman, 1993),
and to appreciate that most gifted children show such an appreciable,
and often significant, scatter of abilities.
this simply represents that their thoughts go
so much faster than their hands can move, and that they see little
sense in making writing an art form when its primary purpose is to
communicate (Webb & Kleme, 1993; Winner, 2000).
ability and achievement test results with gifted children about their
particular abilities, combined with reassurance, can often help them
develop a more appropriate sense of self-evaluation.
unclear whether this should
be considered a mis-diagnosis or a dual diagnosis. Certainly, parents
commonly report that their gifted children have dreams that are more
vivid, intense, and more often in color, and that a substantial
proportion of gifted boys are more prone to sleepwalking and bed
wetting, apparently related to their dreams and to being more soundly
(i.e., intensely) asleep.
concordance would suggest that
giftedness may need to be considered as a dual diagnosis in these
cases, or at least a factor worthy of consideration since the child's
intellect and sense of understanding often can be used to help the
child cope with nightmares.
these sleep patterns show themselves very early in the child's life,
and long-term follow up suggests that the pattern continues into
adulthood (Webb & Kleme, 1993; Winner, 2000). Some highly gifted
adults appear to average comfortably as few as two or three hours sleep
each night, and they have indicated to me that even in childhood they
needed only four or five hours sleep.
conclusion of professionals at
the Meiminger Foundation was that most MPD patients showed a history of
childhood abuse, but also high intellectual abilities which allowed
them to create and maintain their elaborate separate personalities (W.
H. Smith personal communication, April 18, 1996).
children can be both exhilarating and
exhausting. But because parents often lack information about
characteristics of gifted children, the relationship between parent and
child can suffer. The child's behaviors are seen as mischievous,
impertinent, weird, or strong-willed, and the child often is criticized
or punished for behaviors that really represent curiosity, intensity,
sensitivity, or the lag of judgment behind intellect.
power struggles, arguments, temper tantrums, sibling rivalry,
withdrawal, underachievement, and open flaunting of family and societal
traditions may occur within the family.
surprisingly, these are frequent concerns for parents of gifted
children due to the intensity, impatience, asynchronous development,
and lag of judgment behind intellect of gifted children.
characteristics inherent within gifted children have implications
for diagnosis and treatment which could include therapy for the whole
family, not in the sense of develop coping mechanisms for dealing with
the intensity, sensitivity, and herwise may cause them problems later
time that we trained health care professionals to give correct
assessments to gifted, talented, and creative children and adults. At
the very least, we must help professionals gain sufficient
understanding so that they no longer misinterpret characteristics of
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