Over-Identification of ADD/ADHD in the Gifted
by Deborah L. Ruf, Ph.D.
(Originally published in the NAGC newsletter for Guidance & Counseling Division, 2001, with the title Twice Exceptional in the Gifted)
In a little over one year of private practice as a gifted specialist I have confronted the issue of ADD, Attention Deficit Disorder, and ADHD, Attention Deficit Hyperactivity Disorder, myriad times. The first disability involves a high level of distractibility, an inability to focus on one topic and follow it through. ADD manifests itself in the person's starting but not finishing assignments and projects, and not hearing and remembering what one has been told, for example. ADHD generally includes all the qualities of the first disability but also encompasses hyperactivity. A child with ADHD shows excessive activity, especially activity unrelated to what needs to be done or what is expected and desirable behavior.
As far as twice exceptional is concerned, ADD/ADHD is a problem in that the definition and diagnosis can often take the place of recognizing that the child is gifted and misplaced in his academic environment. The child can be put on medication that calms him down and makes him less susceptible to distractions, but the subsequent compliance may take away the zest and curiosity that are a strong hallmark of high intelligence and creativity. It is possible that high intelligence on medication turns itself toward adding complexity to lower level instruction and activities.
Conversely, when children are ADD or ADHD and undiagnosed, life can be more difficult for them and they may go unrecognized as gifted. It is my professional opinion that a highly gifted child who is ADD/ADHD can learn to cope with the concomitant attention difficulties, but that his energies are sapped to the point of disabling him to function as high as he could if on treatment.
The frequency with which the topic arises has necessitated my reading articles, visiting web sites, and talking at length to medical and psychological colleagues in order to familiarize myself with the condition. Almost always, it is the parents of boys who tell me that the school suspects ADHD in their son. The parents learn as much as they can about ADD/ADHD, and the people who call me want to determine first if their son may simply be gifted. Poor academic fit often causes lack of follow-through; and the generally high activity and wide interests of gifted children may make them appear to be too active or distractible.
I have some background working with boys. I have two brothers and have raised three sons, all of whom are gifted and very, very busy, and some have said, “hyper.” I have taught elementary school and am familiar with the higher activity level of boys in general. I mention this because I have a good sense of what is normal for bright children when it comes to ability to concentrate and activity level. If a child truly experiences ADD, he cannot focus on school instruction even when the environment and instructional level are completely appropriate for him. During a one-on-one testing situation with me, I can tell whether or not the child has difficulty with attention and focus, it is likely to evidence itself during our time together. I have a strong bias, after many years of study and experience, toward believing that most children whom the schools and parents believe are ADD, instead are experiencing difficulty attending to and following through on assignments and materials that are below what they are ready to study and address. Obviously it occurs more often in gifted children that the instruction is indeed boring and repetitive. For a number of reasons that are not the focus of this article, most gifted girls cope with inappropriate instruction better than do most gifted boys. Out of approximately 125 children with whom I have worked professionally in the past year, there were only two that I recommended be tested medically for possible ADD or ADHD.
Gifted children sometimes appear to have trouble understanding instruction and focusing because they are baffled by the instruction and expectations. It is difficult for them to believe that this is truly all they have to do to finish the assignment. There must be some catch, some trick; it couldn't be this easy. Many gifted children simply refuse to do the busywork of an assignment when there is clearly nothing to be gained beyond the teacher's approval. Unfortunately, some of these circumspect and independent children fall into a pattern of noncompliance that ill-equips them to recognize when the assignments may actually be helpful and useful.
Among gifted children who are referred for ADD/ADHD assessments, it is boys who eventually test at over 140 IQ who are most frequently mislabeled and sometimes misdiagnosed as being ADD/ADHD. My feeling is that a borderline or questionable case of ADD/ADHD first needs to be addressed by checking the intellectual functioning level of the child, then the educational environment and its appropriateness for the child's ability level, and finally, that the child should be given support in understanding how to deal with occasional frustrations in school or at home. Sometimes parents benefit from taking parenting classes or reading books on parenting.
It is unfortunate but true that medical professionals, school personnel, and counselors are often unaware of the characteristics and needs of gifted children. The proportion of children who are on medication for ADD/ADHD now compared to 20 years ago is many fold larger. I believe that creativity is jeopardized, personalities are unnecessarily reigned in, and the long-term affects of being on medication instead of learning how to deal with distractions that are a part of every day life have not yet been calculated. I believe it is normal for a highly intelligent person to be unusually sensitive to things around him or herself. The individual needs to have practice in following through on things that matter and things that are meaningful. It is important to learn how to budget one's time, and to manage many interests, activities, and obligations. Highly intelligent people can juggle far more activities and interests than people who are less intelligent. It is normal for most gifted children and adults to sometimes have trouble finding a good and healthy balance. In my professional opinion, however, ADD/ADHD is over diagnosed among the gifted and is often erroneously viewed as a twice exceptional condition.
Copyright © Deborah Ruf, 2001. All rights reserved.