Perhaps the biggest challenge in helping gifted students with attention difficulties is getting an accurate diagnosis of them. How are true attention deficits differentiated from the emotional and behavioral shifts common among gifted students? The problem may be compounded by a lack of appropriate educational services in the classroom.
One of the obstacles to an accurate diagnosis is that other conditions mimic attention deficit hyperactivity disorder (ADHD). Children with high levels of anxiety, for instance, may find it hard to persist at a task, may fail to pay close attention to details, and may be forgetful. Depressed teens are prone to angry outbursts and have trouble keeping track of things. Students with nonverbal language disabilities are apt to be disorganized and to neglect to turn in assignments. Highly creative adolescents can be stubborn or messy and frequently shift from one activity to another. Gifted students who spend most of their time in understimulating classrooms may be impatient, bossy, and talkative.
The key to an accurate diagnosis is to have the student evaluated by a trained professional who can take the time to gather information from different sources. There is no definitive test for ADHD. Rather, it is reliably diagnosed only by using standard diagnostic interview methods. School personnel seldom have the training to confirm a diagnosis, and family physicians rarely have the time. Ideally, the diagnosis of ADHD in gifted children is made by a multidisciplinary team that includes at least one clinician trained to differentiate childhood disorders and one person familiar with the common needs and characteristics of gifted children.
The assessment should include three components: behavioral observations collected from people who know the child well and see him or her in a variety of settings (e.g., parents and teachers can be asked to complete behavioral rating scales); a thorough developmental and family history that takes into account the fit between the child’s learning needs and the curriculum; and, if the child’s academic progress is a concern, an evaluation for possible learning disabilities. Learning problems often go undiagnosed in gifted children, and many children diagnosed with ADHD also have learning disabilities.
Furthermore, the symptoms must be present for at least six months, must have been present before age seven, and must cause significant impairment at home or in school. This last point is crucial. If a child meets the other criteria but exhibits little impairment, a diagnosis of ADHD will not be made. People often disagree about the degree of impairment and consequently about the need for a positive diagnosis because the level of impulsivity and inattention required to make one is, ultimately, a matter of subjective judgment.
—Maureen Neihart, PsyD
Maureen Neihart, a clinical psychologist in private practice, has worked with gifted children and their families for more than 20 years.