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Wednesday, March 19, 2014

Overexcitability...can just be giftedness

By Benjamin Hebebrand, Head of School, Quest Academy

By thinking of giftedness as an “exceptional” condition, it follows that those labeled or diagnosed as gifted are indeed exceptional individuals. They are the exception from the norm – most frequently illustrated on the right-hand outer edges of a traditional bell curve of intelligence measures.

There is some concern that the exceptionality of giftedness is occasionally misdiagnosed or mistaken for other exceptionalities, “because specific social and emotional characteristics of gifted children are mistakenly assumed to be signs of pathology,” according to  James T. Webb, psychologist and noted gifted education advocate, who wrote Misdiagnosis and Dual Diagnoses of Gifted Children and Adults.

Among the most common misdiagnoses – or also a common dual diagnosis along with giftedness – is the condition of Attention Deficit/Hyperactivity Disorder. According to M. Layne Kalbfleisch’s and Meredith Banasiak’s ADHD chapter in “Critical Issues and Practices in GiftedEducation,” the two conditions “can share many similar traits including rapid speech, impulsive actions, overindulgence, extra sensitivity to environmental stimuli, intense curiosity, melodrama, tendency to mix truth with fiction, use of image and metaphor, behavior extremes, somatic complaints, and difficulty adjusting to new environments.”

Among the first to link giftedness to what he termed “overexcitabilities” is Polish psychiatrist and psychologist Kazimierz Dabrowski. He identified five areas of intensity:
  1.   Psychomotor
  2.    Sensual
  3.     Intellectual
  4.     Imaginational
  5.     Emotional

According to Dabrowski, these overexcitabilities can bring much joy – there are reasons to celebrate these excitabilities, while the frustrations and negatives that excitabilities may bring about can “be positively dealt with and used to help facilitate the child’s growth,” according to a SENG (Social/Emotional Needs of Gifted Children) newsletter.

Dr. Webb describes it in the following manner: “Gifted children-and gifted adults often are extremely intense, whether in their emotional response, intellectual pursuits, sibling rivalry, or power struggles with authority figures. Impatience is also frequently present, both with oneself and with others. The intensity also often manifests itself in heightened motor activity and physical restlessness.”

The misdiagnosis of ADHD in gifted children may be attributed to the manner in which ADHD is often diagnosed by a collection of behavior checklists, often filled out by parents and teachers. “The behaviors of children with ADHD are generally thought to be caused by a neurological abnormality in the prefrontal cortex of the brain and/or neurotransmitter dysfunction. ADHD behaviors exhibited by gifted children likely have far different explanations,” according to a Winter 2004 Roeper Review article entitled “Gifted or ADHD.” Kalbfleisch and Banasiak have one such possible different explanation:  the failure “to assess how intellectually engaging a (gifted) child’s environment is.” Dr. Webb puts it bluntly by pointing out the boredom gifted children may experience in a classroom – he estimates that gifted students “may spend a quarter to half their day waiting for kids to catch up.” That amount of boredom may indeed cause a gifted student to display ADHD-like behaviors.

So while there is the potential to misdiagnose ADHD in gifted children, there certainly are also correct diagnoses of both giftedness and ADHD. The Diagnostic and Statistical Manual of Mental Disorders(DSM), which outlines a list of behavioral criteria used to identify any of the three ADHD subtypes, states that “individuals with ADHD may show intellectual development in the above-average or gifted range.”
Studies of gifted children with ADHD and gifted children without ADHD show that children with the combined condition “tend to exhibit inconsistency in academic performance, difficulties with handwriting, and prefer group or participatory activities to working alone,” according to Kalbfleisch and Banasiak. Furthermore, gifted students with ADHD will have difficulty acquiring new information at the same speed that gifted students without ADHD are able to demonstrate. “Thus, there is a gap between rapid knowledge acquisition and what a gifted student with ADHD may be able to demonstrate.” Gifted students with ADHD should be given the opportunity to show their knowledge in verbal presentations rather than written recall scenarios.

Interestingly, Kalbfleisch and Banasiak also point out potential benefits of the combined condition of giftedness and ADHD such as high degrees of creativity, propelled by complete immersion to a task that can actually lead to a state of “flow” or “hyperfocus.”

There certainly is the potential to mis- or over-diagnose ADHD, particularly with gifted children. With that thought in mind, it is naturally critical that only a licensed/qualified clinician make such a diagnosis. According to the American Psychiatric Association, “symptoms of hyperactivity must be present for at least six months to a point that it is disruptive and inappropriate for developmental level.”



4 comments:

  1. , “symptoms of hyperactivity must be present for at least six months to a point that it is disruptive and inappropriate for developmental level.
    www.christmasnewyeareve.com

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  2. That’s interesting. How unfortunate of someone's giftedness to be misdiagnosed as ADHD. It’s unfortunate that such ignorance does exist in some medical professionals. Thankfully, there are legitimate psychiatric associations that parents can consult with, though it’s too bad that not everyone is aware of it. Anyway, thanks for sharing this information with us, and hopefully it would help out those who are under the same predicament. Good day!

    Sabrina Craig @ The Law Offices of Joseph M. Lichtenstein

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