Gifted Children with Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder (ADHD) is the most common behavioral disorder of childhood and is marked by a constellation of symptoms including immature levels of impulsivity, inattention, and hyperactivity (American Psychiatric Association, 1994). The National Institutes of Health declared ADHD a "severe public health problem" in its consensus conference on ADHD in 1998. In the ongoing dialogue about ADHD in gifted children, three questions often arise. Are gifted children over-diagnosed with the disorder? In what ways are gifted ADHD children different from gifted children without the disorder and from other ADHD children? Does the emerging research suggest any differences in intervention or support?
There are three subtypes of ADHD: predominantly inattentive type, predominantly hyperactive/impulsive type, and combined type. The combined type is most common and best researched. The DSM-IV states that to meet criteria for a diagnosis of Combined Type ADHD, a child must meet at least six of the nine criteria from both lists and exhibit significant impairment in functioning. Symptoms must occur in more than one setting, have been present for at least six months, and have been present before the age of seven. It is important to note that a child who meets the criteria but doesn't exhibit significant impairment is not diagnosed with the disorder. The subjective determination of what constitutes significant impairment is one of several factors that contribute to the controversy regarding diagnosis and treatment, especially in gifted children.
Differences in Gifted Children and Non-Gifted Children with ADHD
Initial findings suggest two points for consideration (Kalbfleisch, 2000; Kaufmann, Kalbfleisch, & Castellanos, 2000; Moon, 2001; Moon, Zentall, Grskovic, Hall, & Stormant, 2001; Zentall, Moon, Hall, & Grskovic, 2001). First, Kaufman and her colleagues' (2000) work indicates that identified gifted ADHD children are more impaired than other ADHD children, suggesting the possibility that we are missing gifted children with milder forms of ADHD. Second, high ability can mask ADHD, and attention deficits and impulsivity tend to depress the test scores as well as the high academic performance that many schools rely on to identify giftedness. Also, teachers may tend to focus on the disruptive behaviors of gifted ADHD students and fail to see indicators of high ability.
These delays are of concern because early provision of appropriate services is important for academic and social success. Gifted children whose attention deficits are identified later may be at risk for developing learned helplessness and chronic underachievement (Moon, 2001). ADHD children whose giftedness goes unrecognized do not receive appropriate educational services. It is recommended that children who fail to meet test score criteria for giftedness and are later diagnosed with ADHD be retested for the gifted program (Baum, Olenchak, & Owen, 1998; Moon, 2002).
As a group, ADHD children tend to lag two to three years behind their age peers in social and emotional maturity (Barkley, 1998). Gifted ADHD children are no exception (Kaufmann & Castellanos, 2000; Moon, 2001; Zentall, Moon, Hall, & Grskovic, 2001). This finding has important implications for educational placement. As a group, gifted children without ADHD tend to be more similar in their cognitive, social, and emotional development to children two to four years older than children their own age (Neihart, Reis, Robinson, & Moon, 2002). When placed with other high ability children without the disorder, ADHD children may find the advanced maturity of their classmates a challenge they are ill prepared for. Also, gifted children without the disorder may have little patience for the social and emotional immaturity of the gifted ADHD student in their midst. This is not to say that gifted ADHD students should not be placed with other gifted students. The research is clear that lack of intellectual challenge and little access to others with similar interests, ability, and drive are often risk factors for gifted children (Neihart, Reis, Robinson, & Moon, 2002), contributing to social or emotional problems.
Reprinted with the permission of the Council for Exceptional Children. © 2006-2007 Council for Exceptional Children (CEC). All rights reserved.