Does your child possibly have a wrong diagnosis?
Why do many gifted individuals end up with misdiagnoses?
You might be familiar with the scenario: during your son's initial parent-teacher meeting, the teacher notices his high energy levels, his constant movement in class, fidgeting in his chair, or occasionally standing on it... And then the suggestion arises: "This seems like ADHD behavior!" Alternatively, the teacher might approach you on the playground, expressing concern about your daughter's tendency to withdraw in class, always standing alone during recess, prompting the suggestion, "Perhaps further investigation is warranted?"
What leads to numerous misdiagnoses among the gifted? How do we find so many connections between giftedness and conditions like autism, AD(H)D, oppositional behavior, and even depression? What insights can we glean from Dabrowski regarding this issue?
Problematic Behavior
Please note: Teachers lack the authority to suggest or diagnose any disorders, but sometimes you may discern hints of concern regarding your child's behavior. This feeling is often reinforced by observations or comments from people within your social circle, like relatives or friends who visit. Once a seed of doubt is planted, it begins to grow in our minds, prompting questions like, "Could something be going on?"
In their quest to understand their child's behavior, parents may turn to specialized centers focusing on ADHD, autism, or other disorders. This inclination is understandable because every parent wants the best for their child. However, there's a risk that while a label for a specific disorder may be assigned, your child's giftedness might remain unnoticed. This oversight is particularly likely if your child is already underachieving, possibly resulting in IQ test scores that fail to reflect their true potential.
Following a diagnosis, a tailored action plan is typically developed for managing the identified disorder, potentially including medication considerations. Unfortunately, there's often little to no emphasis on addressing the child's giftedness in these plans. Consequently, behavior may improve marginally, if at all. The onus is unfairly placed entirely on the child and their cognitive function, neglecting to consider environmental factors or potential adjustments that could be made to better support them.
Cause of Misdiagnoses
The primary issue lies in the child's behavior, which often mirrors that of children with ADHD, autism, and similar conditions. Furthermore, this behavior is often perceived as disruptive by those around them, particularly teachers. While the child may not be significantly affected by their behavior, it can cause concern among educators. Additionally, the manifestation of behavior can vary depending on the environment, raising questions about its consistency across different settings.
Diagnoses are frequently based solely on these observable behaviors, without sufficient consideration for their underlying causes or contextual relevance. Behavior deemed acceptable in one setting, such as the family environment, may be labeled as problematic in another, such as the classroom. Only when behavior becomes intolerable it is labeled as a disorder, often guided by the criteria outlined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). However, these criteria can be vague and subject to interpretation, leading to inconsistencies in diagnosis.
A significant contributing factor to misdiagnoses is the lack of understanding of cognitive giftedness among professionals responsible for evaluations and diagnoses. Psychologists, psychiatrists, and pediatricians often receive minimal education on the emotional, intellectual, and behavioral characteristics of gifted individuals during their training, leading to oversights in assessment.
Moreover, many traits commonly associated with giftedness, such as the intensity of emotions and behaviors, can resemble symptoms of other disorders. This overlap can result in gifted behavior being misinterpreted as indicative of a psychiatric condition, leading to inappropriate diagnoses and interventions.
Dabrowski
The concept of intensity in gifted individuals has been extensively explored by Kazimierz Dabrowski, a Polish psychiatrist. He introduced the term "overexcitability" to describe heightened responsiveness across various domains.
Giftedness often presents with intellectual overexcitability, characterized by a strong thirst for knowledge, avid learning, intense curiosity, and enjoyment of challenging puzzles. Consequently, gifted individuals may frequently offer correct answers in class, appearing impulsive and displaying behaviors associated with ADHD. Similarly, their strong will and independent nature may lead to a diagnosis of Oppositional Defiant Disorder (ODD). Alternatively, their deep daydreaming and tendency to get lost in thought may result in a misdiagnosis of Attention Deficit Disorder (ADD) due to perceived inattentiveness.
Gifted children who possess intense imaginative abilities, known as imaginational overexcitability, may also be mistakenly diagnosed with ADD. Their rich imagination and dreamy demeanor can create the impression of attention difficulties.
Parents often observe emotional intensity in gifted children, referred to as emotional overexcitability, which includes profound compassion, empathy, and sensitivity, as well as intense feelings of anxiety, anger, or worry. Unfortunately, these emotional extremes may lead to misdiagnoses of depression, bipolar disorder, or ODD.
Sensual overexcitability, linked to heightened sensitivity, usually does not result in misdiagnosis, although heightened sensitivity can exacerbate stress and manifest as anger, frustration, or psychosomatic symptoms during challenging situations.
Lastly, psychomotor overexcitability shares similarities with ADHD, particularly its hyperactive aspect. Children with psychomotor overexcitability may exhibit a strong need for movement, fidgeting, tapping, and speaking rapidly. While this behavior may not hinder their learning, it can disrupt others, prompting further evaluation.
It's important to note that overexcitabilities cannot be directly linked to giftedness. Several studies indicate that the relationship between overexcitabilities and giftedness is not straightforward. Meta-analysis results suggest minor differences between gifted and non-gifted individuals across various subdomains of overexcitability, while other research highlights significant differences between the two groups in intellectual, imaginative, emotional, and sensory overexcitability. In essence, some gifted individuals do not experience these heightened intensities, and some non-gifted individuals do.
Options
I encourage teachers to become more knowledgeable about cognitive giftedness and strong cognitive functioning, emphasizing early identification, especially without overlooking underachieving students. Prioritizing recognition of strong cognitive functioning by teachers can reduce the likelihood of considering other disorders.
To parents, I recommend promptly seeking assessment if you suspect your child is gifted, before exploring other possibilities. However, I understand this might be challenging as parents are often unfamiliar with the concept of cognitive giftedness. Therefore, it's crucial to provide them with accurate information.
Furthermore, psychologists, psychiatrists, pediatricians, and medical practitioners need to be well-educated in giftedness to minimize misdiagnoses.
In addition to accurate information and identification, the testing process is critical, particularly the qualifications of the test administrator. Ensure your child is assessed by someone knowledgeable about the behaviors and traits of gifted individuals, along with expertise in related areas. Consideration of testing by a multidisciplinary team may also be beneficial.
Finally, I advocate for environmental adjustments over labeling a child and burdening them with unwarranted guilt. Rather than searching for the cause of behavior, focus on finding solutions. For instance, active children can be allowed to stand in class, engage in physical exercises after periods of concentration, or release energy by running around the playground. Children easily distracted can benefit from visual aids, step-by-step instructions, or working with a study partner. Similarly, providing noise-canceling headphones can help children who are sensitive to noise. Explore various solutions, and only consider referrals as a last resort.
Preventing Misdiagnoses?
The earlier we identify that a child may be gifted, the lower the likelihood of misdiagnosis. During an initial consultation, our coaches can assess whether there are indications of giftedness or if other factors should be considered. If testing, such as an IQ assessment, is deemed appropriate, they will refer you to one of our psychologists.
In our partner network, you'll find our coaches who are available to schedule an initial consultation. Locate a coach in your vicinity and feel free to reach out via phone or email. Should testing be deemed necessary, they will guide you to our psychologists.
Copyright © 2023 dr. Sabine Sypré, Hoogbloeier® cvba – All rights reserved. No part of this article may be reproduced, in any form or by any means, electronic or mechanical, including photocopying, recording, or by any other means, without prior written permission from the author. Sharing online is permitted provided the author is credited and a link to this article is included.
