ADHD and Children Who Are Gifted-article

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ADHD and Children Who Are Gifted

by T Webb and Diane Latimer

's teachers say he just isn't working up to his ability. He

doesn't finish his assignments, or just puts down answers without

showing his work; his handwriting and spelling are poor. He sits and

fidgets in class, talks to others, and often disrupts class by

interrupting others. He used to shout out the answers to the

teachers' questions (they were usually right), but now he day-dreams

a lot and seems distracted. Does have Attention Deficit

Hyperactivity Disorder (ADHD), is he gifted, or both?

Frequently, bright children have been referred to psychologists or

pediatricians because they exhibited certain behaviors (e.g.,

restlessness, inattention, impulsivity, high activity level, day-

dreaming) commonly associated with a diagnosis of ADHD. Formally, the

Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)

(American Psychiatric Association) lists 14 characteristics that may

be found in children diagnosed as having ADHD. At least 8 of these

characteristics must be present, the onset must be before age 7, and

they must be present for at least six months.

DSM-III-R Diagnostic Criteria For Attention-Deficit Hyperactivity

Disorder*

Often fidgets with hands or feet or squirms in seat (in adolescents

may be limited to subjective feelings of restlessness).

Has difficulty remaining seated when required to.

Is easily distracted by extraneous stimuli.

Has difficulty awaiting turns in games or group situations.

Often blurts out answers to questions before they have been

completed.

Has difficulty following through on instructions from others (not due

to oppositional behavior or failure of comprehension).

Has difficulty sustaining attention in tasks or play activities.

Often shifts from one uncompleted activity to another.

Has difficulty playing quietly.

Often talks excessively.

Often interrupts or intrudes on others, e.g., butts into other

people's games.

Often does not seem to listen to what is being said to him or her.

Often loses things necessary for tasks or activities at school or at

home (e.g., toys, pencils, books).

Often engages in physically dangerous activities without considering

possible consequences (not for the purpose of thrill-seeking), e.g.,

runs into street without looking.

Almost all of these behaviors, however, might be found in bright,

talented, creative, gifted children. Until now, little attention has

been given to the similarities and differences between the two

groups, thus raising the potential for misidentification in both

areas-giftedness and ADHD.

Sometimes, professionals have diagnosed ADHD by simply listening to

parent or teacher descriptions of the child's behaviors along with a

brief observation of the child. Other times, brief screening

questionnaires are used, although these questionnaires only quantify

the parents' or teachers' descriptions of the behaviors (,

1992). Children who are fortunate enough to have a thorough physical

evaluation (which includes screening for allergies and other

metabolic disorders) and extensive psychological evaluations, which

include assessment of intelligence, achievement, and emotional

status, have a better chance of being accurately identified. A child

may be gifted and have ADHD. Without a thorough professional

evaluation, it is difficult to tell.

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How Can Parents or Teachers Distinguish Between ADHD and Giftedness?

Seeing the difference between behaviors that are sometimes associated

with giftedness but also characteristic of ADHD is not easy, as the

following parallel lists show.

BEHAVIORS ASSOCIATED WITH ADHD (BARKLEY, 1990)

Poorly sustained attention in almost all situations

Diminished persistence on tasks not having immediate consequences

Impulsivity, poor delay of gratification

Impaired adherence to commands to regulate or inhibit behavior in

social contexts

More active, restless than normal children

Difficulty adhering to rules and regulations

BEHAVIORS ASSOCIATED WITH GIFTEDNESS (WEBB, 1993)

Poor attention, boredom, daydreaming in specific situations

Low tolerance for persistence on tasks that seem irrelevant

Judgment lags behind development of intellect

Intensity may lead to power struggles with authorities

High activity level; may need less sleep

Questions rules, customs and traditions

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Consider the Situation and Setting

It is important to examine the situations in which a child's

behaviors are problematic. Gifted children typically do not exhibit

problems in all situations. For example, they may be seen as ADHD-

like by one classroom teacher, but not by another; or they may be

seen as ADHD at school, but not by the scout leader or music teacher.

Close examination of the troublesome situation generally reveals

other factors which are prompting the problem behaviors. By contrast,

children with ADHD typically exhibit the problem behaviors in

virtually all settings-including at home and at school-though the

extent of their problem behaviors may fluctuate significantly from

setting to setting (Barkley, 1990), depending largely on the

structure of that situation. That is, the behaviors exist in all

settings, but are more of a problem in some settings than in others.

In the classroom, a gifted child's perceived inability to stay on

task is likely to be related to boredom, curriculum, mismatched

learning style, or other environmental factors. Gifted children may

spend from one-fourth to one-half of their regular classroom time

waiting for others to catch up-even more if they are in a

heterogeneously grouped class. Their specific level of academic

achievement is often two to four grade levels above their actual

grade placement. Such children often respond to non-challenging or

slow-moving classroom situations by " off-task " behavior, disruptions,

or other attempts at self-amusement. This use of extra time is often

the cause of the referral for an ADHD evaluation.

Hyperactive is a word often used to describe gifted children as well

as children with ADHD. As with attention span, children with ADHD

have a high activity level, but this activity level is often found

across situations (Barkley, 1990). A large proportion of gifted

children are highly active too. As many as one-fourth may require

less sleep; however, their activity is generally focused and directed

(, 1992; Webb, Meckstroth, & Tolan, 1982), in contrast to the

behavior of children with ADHD. The intensity of gifted children's

concentration often permits them to spend long periods of time and

much energy focusing on whatever truly interests them. Their specific

interests may not coincide, however, with the desires and

expectations of teachers or parents.

While the child who is hyperactive has a very brief attention span in

virtually every situation (usually except for television or computer

games), children who are gifted can concentrate comfortably for long

periods on tasks that interest them, and do not require immediate

completion of those tasks or immediate consequences. The activities

of children with ADHD tend to be both continual and random; the

gifted child's activity usually is episodic and directed to specific

goals.

While difficulties and adherence to rules and regulations has only

begun to be accepted as a sign of ADHD (Barkley, 1990), gifted

children may actively question rules, customs and traditions,

sometimes creating complex rules which they expect others to respect

or obey. Some engage in power struggles. These behaviors can cause

discomfort for parents, teachers, and peers.

One characteristic of ADHD that does not have a counterpart in

children who are gifted is variability of task performance. In almost

every setting, children with ADHD tend to be highly inconsistent in

the quality of their performance (i.e., grades, chores) and the

amount of time used to accomplish tasks (Barkley, 1990). Children who

are gifted routinely maintain consistent efforts and high grades in

classes when they like the teacher and are intellectually challenged,

although they may resist some aspects of the work, particularly

repetition of tasks perceived as dull. Some gifted children may

become intensely focused and determined (an aspect of their

intensity) to produce a product that meets their self-imposed

standards.

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What Teachers and Parents Can Do

Determining whether a child has ADHD can be particularly difficult

when that child is also gifted. The use of many instruments,

including intelligence tests administered by qualified professionals,

achievement and personality tests, as well as parent and teacher

rating scales, can help the professional determine the subtle

differences between ADHD and giftedness. Individual evaluation allows

the professional to establish maximum rapport with the child to get

the best effort on the tests. Since the test situation is constant,

it is possible to make better comparisons among children. Portions of

the intellectual and achievement tests will reveal attention problems

or learning disabilities, whereas personality tests are designed to

show whether emotional problems (e.g., depression or anxiety) could

be causing the problem behaviors. Evaluation should be followed by

appropriate curricular and instructional modifications that account

for advanced knowledge, diverse learning styles, and various types of

intelligence.

Careful consideration and appropriate professional evaluation are

necessary before concluding that bright, creative, intense youngsters

like have ADHD. Consider the characteristics of the

gifted/talented child and the child's situation. Do not hesitate to

raise the possibility of giftedness with any professional who is

evaluating the child for ADHD; however, do not be surprised if the

professional has had little training in recognizing the

characteristics of gifted/talented children (Webb, 1993). It is

important to make the correct diagnosis, and parents and teachers may

need to provide information to others since giftedness is often

neglected in professional development programs.

*Note. DSM-III-R Diagnostic Criteria For Attention-Deficit

Hyperactivity Disorder reprinted with permission from the " Diagnostic

and Statistical Manual of Mental Disorders, " Third Edition, Revised,

Washington, DC, American Psychiatric Association, 1987.

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