By Teresa Currivan, LMFT
I’m in a therapy session with Peter (not his real name), a high-school-aged boy. His depression is palpable. He’s assuring me that he’s fine and can work harder to keep up his grades. While his ADHD meds helped him get his homework done for a while, “I could stay up all night,” they have since stopped working. He tells me that sometimes he “just can’t focus”, but he’s not able to answer when or why that might happen. When I ask Peter about his artwork, he gets excited; the room seems to lighten. With pride, he talks to me a bit about the process he goes through in creating his work: a lot of the planning is in his head. It becomes clear that with his artwork, he is able to focus.
When we turn to other topics, the room returns to a feeling of fuzzy depression. He’s determined to do his homework and get better grades. But his history shows that no matter how much he promises, and how much effort he puts into it, it’s unlikely this will happen. He wants to fit in.
As a second grader, Peter went through a variety of tests. The result was that he tested as gifted. He was also diagnosed with depression and ADHD. The diagnoses of ADHD and depression are what stuck. His giftedness was ignored by professionals and over time, also by his family and himself.
I witness variations on this story often. It is heartbreaking for all, but particularly so for those of us who have seen the gifted fail. We understand what’s going wrong, or at least where to start in helping a child get out of depression, but how much is a real pathology? How much is due to an ill-fitting education? How much is due to misunderstandings? I wonder how many times James Webb, psychologist and author of “Misdiagnosis and Dual Diagnosis of Gifted Children and Adults”, sat in a room with a gifted individual who suffered from lack of understanding of giftedness rather than any other factor. Those of us who are parents of gifted children or who regularly work with gifted children in these types of situations are grateful for James Webb’s work in the field of gifted psychology and education.
In “Misdiagnosis and Dual Diagnosis of Gifted Children and Adults”, Webb et al. (see complete reference at the end of this article) reaffirm what many of us have found out anecdotally: that changing school fit and understanding the quirks that come along with giftedness can remove many struggles:
“…as a group, gifted children and adults appear to be at somewhat lower risk (for any disorder) than the population at large — at least if their intellectual, social, and emotional needs are being met to a reasonable degree … However, there appears to be a significant likelihood of diagnoses of various disorders — as well as misdiagnoses — if there is educational misplacement or lack of family understanding … Either factor can result in a lack of fit that can create significant stress for these children, as well as for the adults around them.”
Chapters 2 through 8: Diagnoses Explained and Differentiated for the Gifted
As a clinician, curious mother, and human, these are my favorite chapters of the book. Here, in a very structured format, traits of disorders and traits of the gifted are compared and contrasted. The authors further illustrate for us with examples of gifted individuals. Of particular interest is that gifted traits that “look like” these disorders are named, providing insights into why a clinician who doesn’t understand giftedness may misdiagnose.
I caution parents not to use this as a rulebook, nor to try to diagnose your own child, but these chapters can act as a hefty guideline when talking with your child’s practitioner about a diagnosis and provides an understanding of the importance of working with a practitioner who is knowledgeable about giftedness.
The best example from the above section is of ADHD, the “diagnosis du jour” as Webb would say when speaking. (During lectures, he would often joke that there are trends in diagnoses. Years ago, the “diagnosis du jour” for children was bipolar disorder.) The authors believe that ADHD is overdiagnosed in gifted children about 50% of the time. They do, however, emphasize that ADHD does co-occur with giftedness, and sometimes giftedness can mask ADHD symptoms. The book breaks down the three different scenarios using examples (pg. 38), which many will find helpful.
I recommend reading the book cover to cover, especially if you are a clinician. However, if you are a book skimmer, and tend to return to books over time, as many busy parents do, and/or are new to the gifted label, I recommend reading the following topics.
Children with overexcitabilities are passionate. “When they discover numbers, they may say things like, ‘Oh, wow! Nine! What a gorgeous number. Two is so ordinary, but nine!’” With compassion and understanding, the authors explain that gifted people can be intense and sensitive in specific ways. “Their passion and their intensity lead these brighter individuals to be so reactive that their feelings, experiences, or reactions far exceed what one would typically expect.” Webb et al. illustrate well how understanding these traits can greatly impact diagnoses.
The authors write, “Simply put, a sensory integration disorder is present when the sensory organ (eye, ear, etc.) works normally, but the experience or perception of the individual is abnormal.”
Since we cannot experience what the child experiences, there are many misunderstandings and misdiagnoses when sensory disorders are present. This book briefly presents and sums up some of the ways to recognize this disorder in order to appropriately address the issues with a professional.
Learning Styles: Auditory-Sequential vs. Visual-Spatial
In our schools designed for the linear-sequential learner, understanding your child’s learning style is extremely helpful to your child’s success. I often see visual-spatially dominant children who try hard to fit into the auditory-sequential school system. Their failure to “fit in” can be a contributing factor to depression and/or acting out.
Webb et al. discuss some typical problems that can arise for the visual-spatial learners and why these types of learners can be misdiagnosed.
A helpful chart (pg, 17) compares the two types of learners side by side. The auditory-sequential list has traits like: “prefers solving existing problems,” and “prefers concrete tasks that have one correct answer.” The visual-spatial list has descriptions such as “prefers solving novel or self-generated problems,” and “Prefers concepts: better at reasoning than at computation.”
The diagnosis I see most in working with school-aged children is depression. Via references throughout the book and the section on depression, Webb et al. express keen awareness of this, “…it is not uncommon for gifted children to experience a mild to severe depression related to their educational situation; in some of these children, the depression is moderate to severe if the child is educationally misplaced and if the school is not being responsive to the child’s need.”
Lack of Empathy
Gifted children are often misdiagnosed as lacking empathy. Differentiating the many things that can cause that appearance is helpful. Of particular note is the authors’ differentiation between lacking tolerance and lacking empathy – something that all parents, teachers, and practitioners should keep in mind.
It is important to note that human beings, gifted or not, are resilient, and if you are reading this and have misunderstood your child or yourself, know that it’s never too late. Read up on giftedness, connect with gifted groups online and in person, and if needed, seek out a therapist or gifted consultant who you resonate with.
If you have a gifted family, this is the book to keep on the shelf and return to again and again.
Note: The complete reference for this book is “Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, Bipolar, OCD, Asperger’s, Depression, and Other Disorders”, by James T. Webb, Ph.D., Edwards R. Amend, Psy.D., Nadia E. Webb, Psy.D., Jean Goerss, M.D., Paul Beljan, Psy.D., and F. Rich Olenchak, Ph.D., which includes the President of the National Association for Gifted Children, two clinical neuropsychologists, two clinical psychologists, and a board-certified pediatrician formerly affiliated with The Mayo Clinic. (Second Ed: James T. Webb, Edward R. Amend, Paul Beljan, Nadia E. Webb, Marianne Kuzujanakis, F. Richard Olenchak. and Jean Goerss.)
Teresa Currivan is a licensed marriage and family therapist and a school therapist who also coaches parents and adults by phone at Help My Child Thrive Coaching. She specializes in giftedness, twice exceptionality, life changes, creative blocks, family dynamics, and individuals. She lives in the San Francisco Bay Area with her husband and son. You can also find her on Facebook at fb.me/teresacurrivancoaching. She can be reached at firstname.lastname@example.org. **Ask about a free 20-minute phone coaching for first-time clients.**
© 2018 Teresa Currivan
This book review is part of a blog hop over at the amazing Gifted Homeschoolers Forum. Overwhelmed by the many books on giftedness out there? Our group of GHF bloggers have picked out some of the most helpful books and reviewed them here: “The Scoop on Gifted, Homeschooling, and Education: Our Book Reviews”
You might also be interested in some of my other articles such as: What Is a Visual-Spatial Learner?