What Is ADHD and How Is It Diagnosed?
What do we know about Attention-Deficit/Hyperactivity Disorder (ADHD) and gifted kids? ADHD, especially in the gifted, has been in the spotlight of attention, concern, and passion. Three experts in the field conducted an exhaustive study and share their findings with us.
What is ADHD?
The core symptoms of ADHD are impulsivity, inattention, and hyperactivity. Estimates vary but the average occurrence of ADHD in school-aged children is two percent.
In 1999, the Individuals with Disabilities Education Act (IDEA) recognized, for the first time, ADHD and ADD as disorders that should be classified as Other Health Impaired.
What causes ADHD -- genetics or the environment?
Genetic factors are very important in ADHD, as studies of the family, adoption, and twins have shown. However, environmental factors can also cause the ADHD syndrome: factors such as premature birth, head injury, fetal alcohol syndrome, lead toxicity, prenatal maternal smoking, rare endocrine abnormalities, and prenatal exposure to drugs like cocaine.
How is ADHD diagnosed?
There are four subtypes of ADHD, according to the DSM-IV:
Not Otherwise Specified
There are nine symptoms of both inattention and hyperactivity. Six of the nine symptoms must be present to be diagnosed. Also, the symptoms must occur in more than one setting (for example, school and home), must persist for at least six months, and must impair your child enough so that he is not displaying age-appropriate behavior.
Your child often --
1. Makes careless mistakes and doesn't pay attention to details
2. Has difficulty paying attention for long periods of time
3. Doesn't seem to listen to someone speaking directly to her
4. Fails to finish work or projects, and does not follow through
5. Has difficulty organizing herself around tasks and activities
6. Avoids or dislikes projects or games that require concentration
7. Loses necessary tools (pencils, toys, etc.) for projects or activities
8. Is easily distracted by things going on around her
9. Forgets daily activities
Your child often --
1. Fidgets or squirms
2. Leaves his seat or other places where he is expected to remain
3. Runs or climbs or feels restless in inappropriate situations
4. Finds it difficult to play or work quietly
5. Seems driven or always on the go
6. Can't stop talking
7. Blurts out answers before questions have been completed
8. Finds it difficult to wait his turn
9. Interrupts or intrudes on others
Who should diagnose my child?
Ideally, a team -- including a qualified clinician such as a pediatrician, family physician, psychiatrist, neurologist, or psychologist -- should make the diagnosis of ADHD, because only a specialist can tell the difference between ADHD and other physical and psychological problems that mimic ADHD.
Information about these other conditions is rarely available to school personnel, no matter how observant, experienced, or well trained.
For the majority of children, symptoms become clear-cut when they can be observed regularly and compared to other children over a long period of time. Because of this, the classroom teacher is often the best person to make these comparisons (when provided with the proper ratings, checklist, and information). Having said this, remember that only specialists can exclude any other medical, psychological, or psychiatric conditions from the possibility of ADHD.
When the child is also gifted, a specialist in giftedness should also be included to provide information about the child's behavior in comparison to other children of similar abilities.
Gifted and ADHD
Are gifted kids labeled as having ADHD instead of being gifted?
It's actually possible that the two conditions may coexist. Recently, some researchers have expressed concern that children who are gifted are mislabeled as ADHD, and that this mislabeling has been getting out of hand. While there are cases of mistaken diagnosis, no empirical data in the medical, educational, or psychological literature confirms the extent of this concern.
Careful attempts to avoid over-diagnosis must be balanced against a child's need for evaluation and treatment. Again, giftedness and ADHD can coexist in the same child.
Can a gifted child who spends hours focused on a task still have ADHD?
Some parents and professionals assume that a child who can concentrate for a long time cannot have ADHD. This is incorrect. It's understandable that an observer might dismiss the possibility of ADHD, because from all appearances the child is so absorbed in a task that everything around her fades into oblivion.
While this state of rapt attention may be the sign of a creative mind, it may also be "hyperfocus," which is a similar condition that individuals with ADHD frequently experience. You can't tell children with and without ADHD from how they engage in high-interest activities -- such as videos, computer games, or reading for pleasure. The key is effort. How your child performs during projects that require effort -- but aren't necessarily high-interest -- can mark the difference.
So a child with ADHD can concentrate for long periods of time?
ADHD is not characterized by a child's inability to pay attention, but rather is marked by his inability to control his attention. A child with ADHD has great difficulty paying attention to tasks that are not immediately rewarding, that require effort.
While "hyperfocus" can be a positive sign of commitment to a task and a sign of motivation, it becomes a problem when a gifted child is asked to shift from one task to another. In other words, while this intense concentration can be positive for the child's thinking, it can also cause problems in her behavior.
How do gifted kids show ADHD?
ADHD may be less apparent in a gifted child than in a child who struggles more obviously. By virtue of their giftedness, the range of tasks that are perceived as "effortless" is broader for gifted children. And so, missing the symptoms of ADHD may be even more common in gifted kids than misdiagnosing them with ADHD. Some children are able to compensate for their ADHD -- and neither they nor their parents or teachers may be aware of it. Others are more seriously handicapped.
A gifted child's over-reliance on her strengths unintentionally obscures her disability. While emphasizing strengths may highlight a child's gifts and talents, it does not eliminate the reality of the condition. It can, in fact, lead to an even worse dilemma: She can doubt her abilities because of her struggle just to maintain them. If a child is allowed to acknowledge her difficulties as a disability, she may learn appropriate coping skills.
The single most relevant consideration in evaluating ADHD is the degree of impairment a child experiences as a result of his behaviors. A child whose behavior causes him to be impaired academically, socially, or in the development of a sense of self, should be examined from a clinical/medical perspective to exclude potentially treatable conditions, even if his behavior may be recognized as creativity or giftedness.
Should I put my gifted child on medication?
Every child who is impaired does not necessarily need medication. Non-medical interventions can be used at school and at home, and should be tried before more intrusive interventions.
Where Do We Go from Here?
ADHD is not a defect that must be "cured." In fact, ADHD can not only inhibit, but can also enhance the realization of gifts and talents.
Educators of gifted children with ADHD face a difficult task of providing opportunities for students to apply their strengths while also improving upon their deficits. Although the same might be said of any sound educational program, this is more daunting for gifted children with ADHD because of the striking gaps in ability, behavior, and performance it can create.
Educators, parents, and children themselves can meet these challenges only through consistent attention, immeasurable creativity, and enduring patience.
1. Be aware that ADHD and giftedness can coexist.
2. Explore many perspectives in your pursuit of information about ADHD.
3. Remember that the most important measure for diagnosing ADHD is the degree of impairment experienced by the child in two or more settings.
4. Use a multidisciplinary team to arrive at a diagnosis and to develop a comprehensive treatment plan.
5. Familiarize yourself with a variety of educational and behavioral strategies to determine which combinations might be effective for your child.
6. Be cautious about "quick-fix" promises -- whether behavioral, educational, or medical.
7. Be aware that the greatest difficulty for a child with ADHD lies in communicating what he's learned.
8. Determine whether shifting attention is a point of vulnerability for your child, when she is asked to change tasks.
9. Model and support the process of "knowing thyself." Remember that everyone has strengths and weaknesses. You can point out to your child how you yourself use your best skills and compensate for weaker areas. You can then help your child to do the same.
10. Advocate for and support research into ADHD within the gifted population. Contact the NRC/GT website if you know of identical twins (ages 5-16) of which only one has ADHD or ADD.
Where do I go to find out more?
Find out more about ADHD and the Individuals with Disabilities Education Act at www.chadd.org/legislative/govt.htm. Find out more about Special Education and the Law, and more about ADHD in FamilyEducation.com's ADHD information center.
Source: "Attention Deficit Disorders and Gifted Students: What Do We Really Know?" by Felice Kaufmann, M. Layne Kalbfleisch, and F. Xavier Castellanos.