Gifted Students with Learning Difficulties: A Review

The contents of this post have been moved to giftedireland.ie

ADHD, Gifted or Both?

SENG Embarks on International Campaign to Educate Pediatricians

About Possible Misdiagnosis of ADHD in Gifted Children

Intellectually gifted children whose needs are neglected or misunderstood may exhibit traits and behaviors that resemble those of Attention Deficit Hyperactivity Disorder (ADHD) and be wrongly diagnosed, possibly resulting in unnecessary medication and unintended harm, according to the international nonprofit organization Supporting Emotional Needs of the Gifted(SENG). SENG is developing a public awareness effort to alert the pediatric healthcare community to the potential for misdiagnosis. Giftedness education is currently not a standard teaching component in medical schools and is addressed infrequently in the pediatric medical literature.

SENG recently sent a letter of concern to the American Academy of Pediatrics (AAP) in response to the AAP's new guideline discussed in "ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity in Children and Adolescents" (Pediatrics, 2011, Vol 128 [5], November, pp. 1-17.). The new AAP-directed guideline extends the range of ADHD diagnosis from ages 6-12 to ages 4-18, and fails to include the critical possibility that a child's intellectual giftedness may contribute to symptoms similar to ADHD. Thus, precocious preschoolers may be at even greater risk for misdiagnosis.

"There is a reasonable amount of professional literature supporting the need for physicians to consider intellectual giftedness...However, the ADHD rating scales have not yet incorporated this consideration into their manuals, and the Diagnostic and Statistical Manual of Mental Disorders (DSM) only mentions it in passing. Our opinion is that a substantial number of intellectually gifted children are being incorrectly diagnosed as having ADHD," according to a letter from SENG leaders James T. Webb, Ph.D., ABPP-Cl; Marianne Kuzujanakis, M.D., M.P.H.; and Rosina M. Gallagher, Ph.D., NCSP.

In response to SENG's letter, the AAP indicated that it will share the information with its committees reviewing the issue, consider the feedback in its next revision of the ADHD guidelines, publish an article on the topic in its newsmagazine, and propose a session on gifted children at its national conference.

James T. Webb, who also co-authored the book Misdiagnosis and Dual Diagnoses of Gifted Children and Adults and is highly published in the gifted field, believes that while ADHD can and does occur in gifted children, many traits and behaviors characteristic of giftedness are frequently misinterpreted as ADHD, particularly in the very young.

"Some of these traits include being strong-willed, impulsive, impatient with the relative slowness of others, and having the tendency towards heightened sensitivity, perfectionism, and intense focus on personal interests and experiences," Webb says.

"As pediatric healthcare providers become better informed on giftedness issues, they better understand the value of correctly identifying giftedness in their patient population, and are better able to make recommendations to meet their needs via strength-based planning and educational strategies prior to traditional behavioral and medical interventions," he adds.

SENG leaders finally propose that future editions of diagnostic manuals (DSM and ICD) provide specific codes for giftedness in the medical record, and recommend that pediatric clinicians routinely consider giftedness in all developmental assessments, particularly when diagnosing ADHD and relevant behavioral and mental conditions.

About SENG

Founded in 1981, SENG is an organization that empowers families and communities to guide gifted and talented individuals to reach their goals: intellectually, physically, emotionally, socially, and spiritually. With more than 12,000 subscribers to its newsletter, and a board of globally respected authorities on gifted education, SENG offers online resources, shares research, and provides webinars for parents, educators, and healthcare professionals. Its 2012 national conference will be held July 13-14, 2012 in Milwaukee, Wis. For more information, see www.SENGifted.org.

Additional resources

To Label Or Not To Label?

In the US, it is estimated that up to 20% of gifted children may also have a learning disability of some sort, i.e. are twice exceptional. We don’t have figures for Ireland, but I assume they would be roughly similar. Is this accurate? Do these children really warrant a diagnosis or label or are they just plain gifted and displaying behaviour typical of giftedness?

Physical disabilities and some learning disabilities may be easy enough to identify. Others are not so clear-cut, particularly in gifted individuals. What is the difference between ADHD and overexcitability? Does the daydreaming, unfocused child or the one who keeps blurting out the answers in class have a brain which is working at a hundred miles an hour or do they have ADHD? Is a child who does not mix well with their classmates displaying asynchrony or do they have Asperger Syndrome?  Is a child who can be elated one minute and distraught the next, suffering from bipolar disorder or just emotional intensity? Do you see the problem?

In Ireland, very few psychologists, psychiatrists and occupational therapists have expertise in giftedness. So, when faced with these issues, they may be too quick to label. On the other hand, for the very same reason, they may miss the diagnosis of a learning disability if giftedness is masking the problem. It is important to be able to see the big picture because, as Dr Linda Silverman says when describing how the gifted cope with learning disabilities, compensation is a two-edged sword.

Most behaviours or traits have a spectrum and we each display them at different intensities. Much like a graphic equaliser gives a piece of music its overall character, it is the combination of all these behaviours at different levels which gives us each our unique personality. Some of us lie near the centre of the range for all the traits; others fall well to one end or the other of some. Does that indicate a diagnosable condition or are we just a little eccentric?

Let me use ADHD to illustrate my point. I am very disorganised, I procrastinate, I flit from idea to idea without seeing things through, and my house usually looks like a tornado just passed through. Do I have ADHD? Well, I am certainly well up along that particular spectrum! Whether I warrant the label or not, I am not sure. 

Excuse the sexist stereotyping but, consider a married man with ADHD and a personal assistant. His assistant keeps him organised at work and, more than likely, his wife keeps him organised at home. So, it's quite possible that he does fine and may never even know he has ADHD. In contrast, a married woman with ADHD who chooses the traditional role of stay-at-home-mother may be expected to manage the household and organise everyone; herself, her children and her husband. Throw in a child or two with traits of ADHD (it tends to run in families) and a couple of pets and the chances are, she may struggle somewhat. She may, like me, be frazzled! 

So you see, the impact of the “problem” very much depends on life circumstances at any given time. If we choose the “right” job and the “right” partner, we may sail through just fine. Alternatively, we may end up in trouble at various times. My view is that we must be aware of our traits and how they affect us. Firstly, it makes us better able to make good choices and not to be too hard on ourselves when we mess up. Secondly, we can learn strategies that may help us to cope. What works for people with the full-blown disability, may help those with milder traits. It is our job as parents, to help our children to understand themselves in this way and to take responsibility for their behaviour. 

Having said that, there are times when we may need to accept the label and seek help. This is particularly important for our children. It is all very well to say we don’t want them to be stigmatised, but if they are struggling to cope at school, getting a diagnosis or label can be the only way to get support for them. This may make all the difference, not only to their level of achievement, but also to their self-confidence and general well being during their formative years.

References: 

Gifted Children with Learning Disabilities : Lost Treasures by Linda Kreger Silverman 

Overexcitability and the Gifted by Sharon Lind

Asynchronous Development by Jean Goerss

Emotional Intensity in Gifted Children by Lesley Kay Sword

The Two-Edged Sword of Compensation: How the Gifted Cope With Learning Disabilities by Linda Kreger Silverman

Understanding How Gifted and Twice Exceptional Children Can Benefit From OT  by Debra Johnson

Homework Tips For The Easily Distracted

Getting through homework can be a major battle for some students and gifted students are no exception. The reasons are varied: some have ADD/ADHD; some have already been bored by the material in class and just can’t face doing yet more of the same at home; some find it difficult to resist the pull of other more interesting projects. Young people today are digital natives in a vibrant and fast-moving world of technology and information. It must be incredibly difficult for them to switch their minds away from all of that and to focus on the rather more mundane task of homework, particularly when they have been told to use the internet as a resource. Whatever the reason, there is a problem as most teachers expect students to do the homework. It doesn’t matter whether or not they clearly understand the material, it matters that the homework has been assigned and everyone must do it. Over recent years, I have been given some advice which my own easily distracted student has found helpful and I thought it would be useful to share it.

There are two parts to maximising your chances of success:

1. You must establish a routine and a system. Everyone is different in this respect, so you may need to try a few alternatives before you find the one that works best for you. Then you must be tough on yourself and stick to it.

2. You must set yourself up to succeed. The psychology of this is important as constant failure will drag you down whereas constant little successes will make you feel more confident and more likely to succeed further. It doesn’t matter how small the success or how trivial it seems to others. This is about removing fear and dread and replacing it with confidence. As the saying goes, success breeds success.

Before You Go Home

At the end of each class, make sure you have made a note of the homework assigned. If you have any doubts, now is the time to ask.

At the end of the school day, to go through the list of homework and pack your bag carefully before leaving school. A few minutes spent at this point making sure that you bring home all the necessary books and materials may save a lot of time later.

  

Getting Ready

Have a specific starting time so that you can’t keep putting it off.

Some people need a break after school before they begin, others find it better to just keep going. If they take a break, they find it hard to get back into the right frame of mind again. Be very careful about watching TV or going on that games console, as they switch your mind into a totally different mode and it can be very difficult to escape from them and switch back to study mode!

Exercise raises the body's levels of neurotransmitters such as serotonin, dopamine and noradrenaline which aid concentration. You may find that things go better after a rugby game, dancing, a run or even walking the dog.

Make sure you eat something before you start. It’s hard to concentrate on an empty stomach.

Don’t kid yourself. You cannot do homework in front of the TV or while facebooking and texting. Find a place with as few distractions as possible and get your head “in the zone”.

  

Getting Started (the hardest part!)

Have a list of the homework to be done so that you can tick each item off as you finish it.

Decide how much time you think each item should reasonably take.

Then do something quick to begin with, or something you quite like. This way, you will find it easier to get stuck in and get one item ticked off on your list.

Next, do the item that you least want to do so that it isn’t hanging over you all evening. It will give you a boost once it’s done and it’s best to do the most difficult item before you get too tired.

Make a note of the time you start each item and the time you finish it. This helps to show you how much time you are spending and will, eventually, show you how you are improving. It will also be useful to show to any teachers who might doubt your effort!

  

Keeping Going

Some people find doing something active helps concentration. Try chewing gum, using a stressball or a piece of modelling clay/bluetack (this can be used in school too). Try sitting on a move-and-sit cushion or an excercise ball.

Contrary to the usual advice, there are a few people who work better with music in the background...Try it, but be honest about the results! Others find that white noise helps.

If you find yourself drifting off too frequently, set a timer to ring at intervals to bring you back. You might need to begin with just five minutes, or less. Set the timer and know that once you have done five minutes, you have succeeded. Enjoy the success and then go for another five, and so on. It is far better to set the bar low and succeed rather than constantly fail and feel frustrated and panicky. Over time, you should aim to increase the amount of time you go for. Often, when the stress of facing an enormous task is removed, your brain works better and you will actually get much more done.

As you complete each item of homework, tick it off on the list and get up and move around. Get some fresh air or a drink/snack. Just don’t get sucked in by the TV or a video game, though...we all know that vast amounts of time can whizz by when doing those things and before you know it, you will have left yourself with no chance of getting all your work done. 

If All Else Fails

If you find that, despite your best efforts, you are spending hours and hours getting through your work and really struggling to get it all done, speak to your teachers about the problem, or get your parents to do so on your behalf. Once they appreciate that you are trying, they may very well be happy to support you. Maybe they can help you decide how much time each piece of homework should take and maybe they will be happy to accept an incomplete assignment once they know that you have spent a reasonable amount of time on it. Maybe they will suggest that you don’t need to do all the homework at all and that a shorter assignment will do. After all, homework is supposed to reinforce what you learned in class and show the teacher that you have understood it. There is often more than one way to achieve this.

For Parents

For students who have difficulties, it is important that their parents accept the problem as genuine and that they support them. They will be feeling bad enough about themselves as it is, without you adding to the sense of hopelessness and inadequacy. This will include speaking to their teachers to make them aware of the problems so that they can help. It may even mean seeking the advice of a psychologist. Don’t let the fear of labelling get in the way of seeking help. Teachers will have come across similar problems many times before and may well have some useful suggestions to make. Psychologists are trained to offer advice for problems such as these and a little input from one of them can make all the difference.

As with the organisational difficulties discussed in the previous post, it is important that, as your child gets older, they take ownership of these difficulties for themselves. Finding a teacher/mentor who is willing and able to help is very important in this regard as it means your child doesn’t have to continue depending on you, but learns to recognise when they need help and to seek it for themselves as they will have to do once they head out into the world on their own.

Further Reading:

Rewired: The Psychology of Technology. Multitasking Madness by Larry Rosen, PhD

15 Minutes of Excercise "Boosts Children's Concentration" by Jennifer Trueland

How To Improve ADHD Symptoms With Excercise interview with  John J Ratey, MD

Does Your Gifted Child Have ADHD? by Kathleen Nadeau, PhD

Organising A Homework Space For Special Needs Children

How To Do Homework Without Throwing Up by Trevor Romain

My Thoughts On Homework by Justin Tarte, Assistant School Principal

Organising the Gifted but Scatty

Do you have one of those kids who lives in a world of their own much of the time, completely oblivious to the passage of time; who needs constant reminding to "put the other sock on and finish getting dressed"; to "never mind that the dog's water bowl is empty, you have five minutes to eat your breakfast and get out to school"?

Does the start of the day go something like the version on the right below?

llustration by Buck Jones, used with the kind permission of Allie Golon of Visual-Spatial Learners

You finally get them out the door and are just recovering when you spot the Irish homework that was slaved over for hours the night before, sitting on the table. Or the text arrives to say "I've forgotten my maths book", "forgotten my lunch", "forgot there was P.E. today"...and so begins that inner battle: if you constantly bail them out they'll never learn, so you should let them suffer the consequences of not planning ahead and paying attention, versus the gut feeling that they really can't help it and will be devastated to turn up in class without all the right things.

In my experience there are some kids who, by suffering the consequences of their actions or lack of them, will quickly learn to be better organised. However, there are some who really do have genuine organisational difficulties related to what are known as executive skills deficits. No matter how hard they try, they always struggle to be organised. They know this and it frustrates them, causes them distress and makes them feel useless.

Sometimes the issue is just delayed development of executive skills, sometimes it’s ADHD, sometimes it’s that your kid is a visual-spatial learner. Whatever the reason, recognising for themselves the tasks with which they struggle and learning how to best to work around the problem is something that will stand to them forever. Plenty of scatty, disorganised people go on to lead productive, creative and fulfilled lives. For them to be left to constantly mess up or to have you forever picking up the pieces for them is hugely damaging to their self esteem and will delay their independence. The trick is to get the balance right between being supportive and allowing to learn by failure.

As a parent, I have found it helpful to avoid comparison of my children's progress in this area with that of other children of the same age. My goal is to ensure that, by the time they reach adulthood, they have learned to be as independent and self-sufficient as possible and are ready to leave the nest. In the meantime, they may need a little more support than their peers, but it's not a competition. It can also be helpful to discuss the problem with your child's teachers so that they understand and can work with you. It is absolutely vital that your child is included in the process so that they take responsibility for their own progress and learn to advocate for themselves as they get older.

Here are some tricks which help them to cope better.

Getting out in the morning:

1. Mornings are usually hectic and full of distractions, so pack your schoolbag and look out all your clothes before going to bed the night before. Use the school timetable to check off what is needed.

2. Set a timer in your bedroom to go off when it really is time to be dressed and ready to go for breakfast. (To begin with, mum may need to pop her head around the door at intervals to make sure progress is being made. Don’t bite it off!)

3. Follow a routine and do everything in the same order so you don’t leave anything out.

4. No TV or other distractions!

5. Have a mental checklist of the essentials and go through it before you leave. Schoolbag, lunch, money, bus ticket...whatever you need, but keep it short or you’ll forget items. My own list, which I automatically recite on my way out the door, is “keys, money, phone”.

In school:

6. If you have a homework journal, USE IT. If you don’t have one, get one. Write in, not just the homework given, but when it is due and any other special announcements. eg If the teacher tells you there is a test or you must bring in a particular item next Wednesday, write a note in next Tuesday’s slot to remind you

7. Colour code your books. You can buy sheets of coloured stickers in various shapes and allocate one to each subject eg red circles to maths, blue squares to English etc. Stick these to the spine of all your books, copybooks included. Then, when you look into you locker, you will see quickly which books you need for each class...provided you take the time to keep your locker tidy.

8. Colour code your timetable to match the book system.

9. Make lots of timetables. Stick one where you do your homework, one in the kitchen, one inside your locker. Make a small one, laminate it and keep it in your pocket.

Most importantly:

10. Accept that this is not your fault and, once you are doing your best, don't be too hard on yourself. If you keep working at it, after a while, these habits become automatic and you will find life much easier. Some of us spend our whole lives using to-do lists and little tricks to keep us on track.

Further reading for the frazzled:

Getting Your Kids Out The Door - With Their Shoes! by Allie Golon

Smart But Scattered Peg Dawson and Richard Guare

Visual Spatial Learners Gifted Development Centre

Visual Spatial Resource

Executive Function, What Is This Anyway? Chris A. Zeigler Dendy

Executive Function Issues

Parenting Your Gifted Child With ADHD Davidson Institute for Talent Development

For my next trick, I will be bringing you some homework tips for the easily distracted.