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Does your Gifted Child have ADD (ADHD)?

Kathleen Nadeau, Ph.D.

A parent who searches the internet for information on gifted children with ADD (ADHD) will find an array of confusing and contradictory information. The public's stereotyped image of a child with ADD (ADHD) is typically a young boy who does poorly in school, who is impulsive, highly distractible, and often has behavior problems at home and at school. Given this negative image of ADD (ADHD), it's no wonder that many articles argue against using this label for gifted students. One such article characterizes the child with ADD (ADHD) as having poor attention "in almost all situations," with little ability to persist at tasks, a child who is impulsive, restless, and has difficulty obeying rules and regulations - in other words, a "bad" kid.

What many parents, and even many professionals, may not know is that our understanding of ADD (ADHD) has evolved significantly over the past ten to fifteen years. While there is certainly a subgroup of challenging children who function poorly at school and at home, there are many children with ADD (ADHD) whose behavior and performance bears very little resemblance to the difficult, disruptive child described above.

What do bright students with inattentive ADD (ADHD) look like?

Children of above average intelligence, with few hyperactive/impulsive symptoms, typically pose no behavior problems in the classroom and often work hard to hide their ADD (ADHD) struggles - especially if they are female. These children often do well in elementary school, where their intelligence more than compensates for the challenges posed by ADD (ADHD).

For some of these bright students, their unraveling begins in middle school when the demands for productivity, independence, and organization increase dramatically. This is a time when there is a sharply increased demand on the "executive functions" of the brain. Because most research on ADD (ADHD) has been conducted on elementary school aged children, we have not paid adequate attention to executive function problems associated with ADD (ADHD). In elementary school, we do not expect children to monitor themselves, to keep track of time accurately, to keep their own schedule, or to plan, organize and prioritize. A child's mother, father, and teacher take responsibility for most of these functions. Then suddenly, as a child enters middle school, he or she is faced with a complex schedule, multiple teachers, and greatly increased organizational demands.

I will always remember a highly gifted student with ADD (ADHD) whom I evaluated a number of years ago. He had just gained admission to a highly competitive public science and technology magnet high school. A ninth grader very small for his age, he told me of his efforts to keep up with the demands. Unable to organize his books and papers well, he found that he often arrived in class without all of the necessary items. Often, they had been left in his locker. His solution to this problem was to carry ALL books and papers with him at all times in a huge backpack that he could barely carry. To add insult to injury, he tearfully reported that efforts to be sure he had what he needed in all of his classes were criticized by a teacher who told him that he was not allowed to carry such a large backpack through the crowded school hallways. "That's what your locker is for!" she exclaimed. In this instance, the burden of struggling with ADD (ADHD) was quite literal - a backpack that this student could barely carry combined with criticism rather than understanding of his intense efforts to keep up.

Other gifted students with ADD (ADHD) continue to function well academically, at least on paper, through high school. Their behind-the-scenes behaviors tell a different story, however - chronic anxiety, all-night study sessions prior to exams, homework that takes hours longer than their gifted non-ADD(ADHD) counterparts, struggles with procrastination, and last-minuite completion of papers and projects. While their grades may look good, their ADD (ADHD) symptoms are increasing as demands increase.

A number of students with ADD (ADHD) may not encounter significant struggles until they are away at college - where the structures, routines, and supports of home are suddenly missing. Some parents, desperate to help their son or daughter succeed in college, resort to becoming their child's long-distance coach, calling to wake them in the morning, keeping detailed track of assignments and exam dates and constantly reminding and advising their child regarding daily to-do's and routines.

The more academically inclined and more intelligent the student with ADD (ADHD), the later he or she begins to encounter serious challenges related to ADD (ADHD). Some with ADD (ADHD), for example, graduate from medical school, but are unable to pass their medical boards, or complete all course requirements for a Ph.D., but never complete the dissertation.

The possibility of ADD (ADHD) should not be rejected because your child is currently doing well academically. Even when academic performance is high, the hidden cost of ADD (ADHD) may be taking a toll. Gifted students with ADD (ADHD) often struggle with anxiety, even when grades are high. They may also suffer when required to do unnecessary, repetitive work that less gifted students may need, but which only serves as a frustration for a gifted student.

When should you consider the possibility of ADD (ADHD) in your gifted child?

1. Do others in the family show signs of ADD (ADHD)?

• Do any siblings show more obvious signs of ADD (ADHD)?
• Do either of the parents show signs of ADD (ADHD) - albeit undiagnosed - for example, problems with organization, planning, time management, forgetfulness, and difficulty with paperwork?
• Is either parent very bright, but didn't go as far in school as would be expected?
• What about grandparents?
• Aunts and uncles?

  ADD (ADHD) rarely exists in a vacuum. It's a family affair (as is giftedness).

2. Then consider the following questions about your gifted child:

1. Does your child have a poor sense of time?

2. Does your child struggle with procrastination, typically beginning homework when it's nearly time for bed?

3. Is your child a night owl who seems to get a "second wind" later in the evening?

4. Is your child an "absent-minded professor"?

5. Does your child hyper-focus to the extent that he or she doesn't hear you when you call?

6. Is your child a dawdler who has great difficulty getting up on time in the morning, and getting ready for school once he or she is out of bed?

7. Is he or she very likely to misplace personal items - jackets, keys, wallets, etc.?

8. Do you find that you need to repeat multi-step directions because your child hasn't registered all of the steps?

9. Do you send your child upstairs for something only to find that they have completely forgotten their mission and are sidetracked by something else?

The child described above presents a very different picture from the stereotyped child with ADD (ADHD) who is impulsive, over-active, with a short attention span and little inclination to follow the rules.

What happens when inattentive type ADD (ADHD) is combined with giftedness?

Sometimes, ADD (ADHD)-like traits are intensified! For example, read Web's (1993) description of gifted children. According to Web:

• gifted children often daydream and pay little attention with not interested (ditto for ADD (ADHD)!);
• they have low tolerance for tasks that seem irrelevant (ditto for ADD (ADHD)!);
• they may have a high activity level with little need for sleep (ditto for ADD (ADHD)!);
• they may be emotionally intense and engage in power struggles (ditto for ADD (ADHD)!);
• and they may often question rules and traditions (ditto for ADD (ADHD)!).

What are the risks when ADD (ADHD) is overlooked in gifted children?

Sadly, sometimes "giftedness" and "ADD (ADHD)" seem to cancel each other out - in the eyes of the school and in the eyes of the student him or herself. For example, a college freshman was referred to me by her very concerned mother when "Rose" found herself feeling overwhelmed by the demands of managing her life as a college student away from home for the first time. Rose's mother believed, accurately, that Rose was a gifted student with ADD (ADHD).

Rose, however, believed that she was neither gifted nor ADD (ADHD). As Rose put it, "I know what gifted is. Lots of my friends in high school were gifted. They didn't need to study nearly as long as I did. They made better grades, and they got higher scores on their SATs. If I were gifted, I wouldn't be having the problems I'm having now!" Rose denied her ADD (ADHD) as well. "I don't know why my mother thinks I have ADD (ADHD). I'm not at all like the kids I knew in school with ADD (ADHD) - the ones who took Ritalin. They never read or studied. They were hyper and hated school. I'm not like that. I read all the time and I'm certainly not hyper!"

For Rose, and for many gifted students like her, her giftedness was masked by untreated ADD (ADHD), and her ADD (ADHD) went unrecognized because Rose didn't fit the ADD (ADHD) stereotype. The cost for this hidden disorder - demoralization and chronic under-functioning.

What should a parent do if they suspect their gifted child has ADD (ADHD)?

First, they should seek an evaluation by the best-qualified professional that they can find. Parents should make sure that the professional they select has experience evaluating gifted students with ADD (ADHD).

Parents need to learn more about what ADD (ADHD) looks like in bright, inattentive ADD (ADHD) students, and help their son or daughter to learn about this too. Parents who suspect that they too have ADHD should talk openly to their son or daughter about their own struggles.

They should help their gifted son or daughter understand that struggles with postponed assignments, sleep difficulties, incomplete homework, careless errors on tests, and unpredictable memory lapses may all be part of a very treatable condition.

It's important that parents also teach their gifted son or daughter about the very positive traits often shared by gifted individuals with ADD (ADHD):

• patterns of "divergent" thinking that can lead to rare insight,
• a wealth of creative ideas,
• an ability to hyper-focus,
• and tremendous drive and energy that can be brought to bear on an activity when a gifted person with ADD (ADHD) directs his attention toward activities that are in his areas of strength and interest.

Parents should seek comprehensive treatment. Studies suggest that the most effective treatment for ADD (ADHD) combines stimulant medication with solution-focused, cognitive/behavioral counseling.

Parents shouldn't delay if they suspect ADD (ADHD) in their gifted child. Even if their child is doing well in school, the cost of doing well only increases as demands and expectations increase. But more importantly, ADD (ADHD) is a quality-of-life disorder that can affect all aspects of life. Untreated ADD (ADHD) can have a negative impact on self-esteem, on peer relations, and can lead to chronic sleep difficulties, and to chronic stress that may develop into anxiety and/or depression as life becomes increasingly challenging.

The great advantage of an early diagnosis is that a gifted child will have a better opportunity to make critical life decisions that are more ADD (ADHD)-friendly, and will have a greater chance of reaching his or her true potential.