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From Mensagenda - November 2002
Twice Exceptional - ADD and Gifted
by Deborah Ruf, Ph.D.
In a little more one year of private
practice as a gifted specialist I have confronted
the issue of ADD, Attention Deficit
Disorder, and ADHD, Attention Deficit
Hyperactivity Disorder, myriad times.
The first disability involves a high level
of distractibility, an inability to focus on
one topic and follow it through. ADD
manifests itself in the person’s starting
but not finishing assignments and
projects, and not hearing and remembering
what one has been told, for example.
ADHD generally includes all the qualities
of the first disability but also encompasses
hyperactivity. A child
with ADHD shows excessive
activity, especially activity
unrelated to what needs to
be done or what is expected
and desirable behavior.
As far as twice exceptional
is concerned, ADD/
ADHD is a problem in that
the definition and diagnosis
can often take the place of
recognizing that the child is
gifted and misplaced in his
academic environment. The
child can be put on medication
that calms him down
and makes him less susceptible
to distractions, but the
subsequent compliance may
take away the zest and curiosity
that are a strong hallmark of high
intelligence and creativity. It is possible
that high intelligence on medication turns
itself toward adding complexity to lowerlevel
instruction and activities.
Conversely, when children with ADD
or ADHD are undiagnosed, life can be
more difficult for them and they may go
unrecognized as gifted. It is my professional
opinion that a highly gifted child
with ADD/ADHD can learn to cope with
the concomitant attention difficulties, but
that his energies are sapped to the point
of disabling him to function as high as he
could if on treatment.
The frequency with which the topic
arises has necessitated my reading articles,
visiting Web sites, and talking at
length to medical and psychological colleagues
in order to familiarize myself with
the condition. Almost always, it is the
parents of boys who tell me that the school
suspects ADHD in their son. The parents
learn as much as they can about ADD/
ADHD, and the people who call me want
to determine first if their son may simply
be gifted. Poor academic fit often causes
lack of follow-through; and the generally
high activity and wide interests of gifted
children may make them appear to be too
active or distractible.
I have some background working with
boys. I have two brothers and have raised
three sons, all of whom are
gifted and very, very busy,
and as some have said,
“hyper.” I have taught elementary
school and am familiar
with the higher activity
level of boys in general.
I mention this because
I have a good sense of what
is normal for bright children
when it comes to ability to
concentrate and activity
level. If a child truly experiences
ADD, he cannot focus
on school instruction even
when the environment and
instructional level are completely
appropriate for him.
During a one-on-one testing
situation with me, I can tell whether
or not the child has difficulty with attention
and focus; it is likely to evidence
itself during our time together. I have a
strong bias, after many years of study
and experience, toward believing that
most children whom the schools and parents
believe are ADD, instead are experiencing
difficulty attending to and following
through on assignments and materials
that are below what they are ready
to study and address. Obviously, it occurs
more often in gifted children that the
instruction is indeed boring and repetitive.
For a number of reasons that are not
the focus of this article, most gifted girls
cope with inappropriate instruction better
than do most gifted boys. Out of approximately
125 children with whom I
have worked professionally in the past
year, there were only two that I recommended
be tested medically for possible
ADD or ADHD.
Gifted children sometimes appear to
have trouble understanding instruction
and focusing because they are baffled by
the instruction and expectations. It is difficult
for them to believe that this is truly
all they have to do to finish the assignment.
There must be some catch, some
trick; it couldn’t be this easy. Many gifted
children simply refuse to do the busywork
of an assignment when there is
clearly nothing to be gained beyond the
teacher’s approval. Unfortunately, some
of these circumspect and independent
children fall into a pattern of noncompliance
that ill-equips them to recognize
when the assignments may actually be
helpful and useful.
Among gifted children who are referred
for ADD/ADHD assessments, it is
boys who eventually test at over 140 IQ
who are most frequently mislabeled and
sometimes misdiagnosed as being ADD/
ADHD. My feeling is that a borderline or
questionable case of ADD/ADHD first
needs to be addressed by checking the
intellectual functioning level of the child,
then the educational environment and its
appropriateness for the child’s ability
level, and finally, that the child should be
given support in understanding how to
deal with occasional frustrations in school
or at home. Sometimes parents benefit
from taking parenting classes or reading
books on parenting.
It is unfortunate but true that medical
professionals, school personnel, and
counselors are often unaware of the characteristics
and needs of gifted children.
The proportion of children who are on
medication for ADD/ADHD now compared
to 20 years ago is many-fold larger.
I believe that creativity is jeopardized,
personalities are unnecessarily reigned
in, and the long-term effects of being on
medication instead of learning how to
deal with distractions that are a part of
every day life have not yet been calculated.
I believe it is normal for a highly
intelligent person to be unusually sensitive
to things around him- or herself. The
individual needs to have practice in following
through on things that matter and
things that are meaningful. It is important
to learn how to budget one’s time,
and to manage many interests, activities,
and obligations. Highly intelligent people
can juggle far more activities and interests
than people who are less intelligent.
It is normal for most gifted children and
adults to sometimes have trouble finding
a good and healthy balance. In my professional
opinion, however, ADD/ADHD
is over-diagnosed among the gifted and
is often erroneously viewed as a twice
exceptional condition.
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