It’s interesting that I would find myself advocating for the gifted, given my own adverse early experience with the gifted education program in grade school. Back then, the program was called Mentally Gifted Minors (MGM); literally correct, but politically… not so much. Two months into the 3rd grade, the children who had spent the last couple of years together in the “accelerated group” were herded in for the day of reckoning, the “MGM test.” My small group of friends all passed the test, and I did not (in retrospect, I’m certain it was a VIQ-PIQ discrepancy that was not further analyzed by the psychologist. At least that’s what I tell myself).
I can remember dwelling on how lucky they were, those MGM kids. Part of an elite group who departed from our classroom at 10:20 every morning, leaving the rest of us to wallow in our ordinariness. Lucky smart kids, not a worry in the world. Decades later I realize that I could not have been more wrong. Gifted individuals are among the most misunderstood people I have ever come across.
Unfortunately, being misunderstood can lead to being misdiagnosed. When not sufficiently challenged in the classroom, gifted students may quickly lose interest, daydream, and appear quite distracted. They may experience racing, spontaneous, rapidly produced thoughts that seem to go every which way at once, known as “divergent thinking.” Overexcitablity is a very common characteristic of gifted kids that is often mistaken for hyperactivity. Executive functioning skills can be late to develop in gifted kids, resulting in disorganization and scatteredness. It is easy to see why so many gifted children are misdiagnosed with ADHD.
Gifted individuals often question rules and authority, and have particular difficulty with things that do not make rational sense to them. Homework and busywork (work assigned for the sake of doing work) can be particularly contentious areas. Many a gifted student has asked the question, “Why do I have to write a page if I can say it in a paragraph?” Redundancy can be torturous, and they will often get to a point of refusing to comply. This is often chalked up to oppositionality, maybe even resulting in a formal diagnosis of Oppositional Defiant Disorder. Interestingly, when one takes the time to listen with an empathic ear to a student in this situation, there is almost a sense of genuine physical pain associated with academic boredom, lack of challenge, and working just to “jump through hoops.” There is almost always a desire to succeed and even to please, yet the requirements can feel nothing short of unbearable. Our natural impulse is to say, “Either you do these things, or you don’t graduate, simple as that.” Yet, after observing this quandary for so many years, I’ve come to the realization that it is anything but simple. Side note: Our educational system does not adequately address the needs of the gifted, but that is a topic for another day.
Gifted children often think and communicate differently than their age peers, which can result in a social disconnect. The combination of intellectualized language, interests that are not typical of their age, and difficulty relating socially with peers will often result in a diagnosis of Autism Spectrum Disorder. Gifted kids can be perfectionistic, thereby fearful of making mistakes and likely to desire a good deal of order. This frequently earns them the diagnosis of… you guessed it, Obsessive-Compulsive Disorder (OCD).
Giftedness is certainly not mutually exclusive from disorders such as ADHD, ODD, OCD, and autism. In fact, there is a term for gifted people who struggle with one or more mental health disorders: twice-exceptional (or “2e” for the savvy). However, when working with a gifted individual, it is crucial to examine any presenting symptoms in the context of giftedness before assigning a formal mental health diagnosis.
As important as it is to avoid pathologizing gifted characteristics and behaviors, it is equally important to recognize a legitimate learning, processing, or mental health problem in a gifted person. There is much research to suggest, for example, a greater presence of slow processing speed in gifted students than students of average intelligence. Nevertheless, countless high-performing gifted students are excluded from gifted and talented education programs every year because they do not score high enough on the Otis-Lennon School Ability Test (OLSAT), the instrument most commonly utilized for the purpose of entry into gifted programs. Why does this happen? The OLSAT happens to be a timed test.
Research has also revealed that gifted individuals show an increased proneness to depression and anxiety. What is not clear is whether these disorders occur organically, or as a result of other “gifted characteristics” that tend to be taxing to the psyche. Very early on, gifted children often struggle with existential concerns that many adults will not lose sleep over in their lifetime. They may worry about environmental issues, mistreatment of groups or individual members of society, or tragic circumstances in other parts of the world. Unable to share these concerns in a meaningful way with peers, they are left to ponder them alone. Gifted people often present with an emotional sensitivity that causes them to experience feelings, both positive and negative, much more intensely then their non-gifted counterparts. In addition, a tendency toward perfectionism, difficulty relating to age peers, and the inevitable school-related struggles all may contribute to this relatively higher incidence of depression and anxiety among the gifted.
A hallmark feature that seems to cause the most problems for gifted children is known as “asynchronous development.” Children who are very bright tend to elicit the expectation that they will be advanced in all areas, but this is most certainly not the case. Examples of asynchronous development include the child whose verbal skills are highly advanced, yet he is unable to write legibly; the child whose academic skills are grade levels ahead, yet she can’t ride a bike or jump rope; the child who quotes Shakespeare, yet is far behind in social skills. Asynchronous development is yet another factor that contributes to the high probability that the gifted person will be misunderstood.
Finally, many a gifted person has gone under the radar due to the policy of our educational system to utilize test scores as determinants of giftedness. Currently, the most common instruments used to assess for giftedness are the OLSAT (mentioned above) and the Wechsler IQ tests. The Wechsler tests measure intelligence in terms of cognitive domains, or indexes. In keeping with their asynchronous nature, gifted individuals frequently obtain lower scores (often significantly lower) on the Working Memory and Processing Speed indexes, most commonly the latter. In many cases, the Full-Scale IQ is impacted such that the score falls below 130, the magic number required by most educational programs in order to be considered gifted. While IQ is a central component of giftedness, its measurement has consistently been fraught with difficulty in this population. It is important that, in addition to IQ, we take into account the multitude of behaviors and characteristics outlined in this article when determining giftedness.
Can psychologists put the gift back in gifted? Maybe not. But we can increase our awareness of the gifted profile, thereby avoiding the tendency to pathologize normal gifted behaviors. We can be sensitive to the plight of the gifted. And we can take great care never to assume that the gifted person sitting across from us has the world on a string, simply by virtue of his high level of intelligence.
Misdiagnosis and Dual Diagnosis of Gifted Children and Adults by James T. Webb et al.