Troxclair gt adhd by Lamar University

Gifted, ADHD, Either, Neither, or Both?

Session presented by Dr. Debbie Troxclair Lamar University/Teacher Education Department debbie.troxclair@lamar.edu

What’s in a name? That which we call a rose by any other name would smell as sweet.

--Shakespeare: Romeo and Juliet • Does my child have ADHD?

• Does my child exhibit traits and abilities which indicate giftedness and/or creativity? • Does my gifted and/or creative child have ADHD?

Questions and Concerns

distractibility impulsivity hyperactivity

Problematic Behaviors Attention

Persist ence

Rul es

Inhibition vs. Intensity

Is it giftedness or ADD/ADHD? ADHD

Giftedness

(Barkley, 1990)

(Webb & Latimer, 1993)

Poorly sustained attention in almost all situations

Impulsivity, poor delay of gratification

Diminished persistence on tasks having no consequences

Poor attention, boredom, daydreams in specific situations

Lower tolerance for persistence on seemingly irrelevant tasks

Impaired adherence to commands to regulate or inhibit behavior in social contexts

Judgment lags behind development of intellect

Intensity may lead to power struggles with authorities

More active, restless than normal children

High energy level, may need less sleep

Information Processing Model ADHD

(Kirk, Gallagher, Coleman, & Anastasiow, ppt slides, chapter 1)

Behavioral Characteristics of Gifted

Webb, J., Amend, E., Webb, N., Goerss, J., Beljan, P., & Loenchak, F. (2005). Misdiagnosis and dual diagnoses of gifted children and adults: ADHD, Bipolar, OCD, Aspergerâ&#x20AC;&#x2122;s, Depression and other disorders. Scottsdale, AZ: Great Potential Press p. 4-5.

Unusually large vocabularies and complex sentence structure Greater comprehension of subtleties of language Longer attention span; persistence Intensity and sensitivity Wide range of interests Highly developed curiosity and limitless questions Interest in experimenting and doing things differently Tendency to put ideas or things together in ways that are unusual, not obvious, and creative (divergent thinking) Desire to organize people and things, primarily through devising complex games Unusual sense of humor Have imaginary playmates Able to retain much information; unusual memory Largely teach themselves to read and write as preschoolers Learns basic skills more quickly, with less practice

Characteristics, Behavior Patterns, & Environments which provide the Potential for Misdiagnosis Webb, J., Amend, E., Webb, N., Goerss, J., Beljan, P., & Loenchak, F. (2005). Misdiagnosis and dual diagnoses of gifted children and adults: ADHD, Bipolar, OCD, Aspergerâ&#x20AC;&#x2122;s, Depression and other disorders. Scottsdale, AZ: Great Potential Press p. 10-31.

Intensity/Sensitivity/Overexcitabilities â&#x20AC;˘ (Intellectual, Imaginational, Emotional, Psychomotor, Sensual)

Thinking and Learning Styles

Idealism

Peer Relations

Asynchronous Development

Interest Patterns

Creativity Problems from Educational Misplacement or Lack of Family Understanding

Intensity: Excessive Personalities/Overexcitabilities

Heightened response to stimuli

their passion and intensity lead them to be so reactive that their feelings, experiences, or reactions far exceed what one would typically expect

Overexcitabilities

occur in one or more of the 5 areas

Intensity: Excessive Personalities/Overexcitabilities

Webb, J., Amend, E., Webb, N., Goerss, J., Beljan, P., & Loenchak, F. (2005). Misdiagnosis and dual diagnoses of gifted children and adults: ADHD, Bipolar, OCD, Asperger’s, Depression and other disorders. Scottsdale, AZ: Great Potential Press p. 10-15.

Intellectual Overexcitability = curiosity, asking probing questions, concentration, problem solving theoretical thinking • Introspective, enjoyment for solving puzzles that involve focus, concentration, and problem solving, may be content to sit and contemplate by themselves for long periods of time • Focus on moral concerns and issues of fairness • Independent thinkers, keen observers • May be impatient if others don’t share their excitement about an idea

OCD

Emotional Overexcitability = extreme and complex emotions and intense feelings Imaginational Overexcitability = rich imagination, fantasy play, animistic thinking, daydreaming, dramatic perception, the use of metaphors, imaginary playmates

• From strong emotional attachments, show a heightened concern for and reaction to the environment around them, are often accused of over-reacting • Strongly compassionate, empathetic and sensitive • May show frequent temper tantrums and displays of rage • May show profound sadness over the plight of others as well as elation over some unexpected good fortune.

Neurotic

Intensity: Excessive Personalities/Overexcitabilities

DANGER

Others find these people exhausting to be around

Minds may be riveted to tasks mentally, their bodies are likely to fidget and twitch in their excitement in ways that can resemble hyperactivity; jiggle their foot or legs when engaged with rapt attention

When tense = talk compulsively, act impulsively, display nervous habits, show intense drive (workaholism), compulsively organize, become quite competitive, misbehave

Psychomotor Overexcitabilities = heightened excitability of the neuromuscular system and augmented capacity for being active and energetic

Never seem to be still, talk constantly HAS HIGH POTENTIAL OF BEING MISDIAGNOSED AS ADD/ADHD!!!!!

Intensity: Excessive Personalities/Overexcitabilities

Tendency to avoid or minimize certain settings of overstimulation Tags in the back of shirts, fluorescent lights, perfumes, texture and taste of foods, normal noise levels exhaust them

Sensual Overexcitability â&#x20AC;&#x201C; seeing, smelling, tasting, touching, hearing are much more heightened May get great pleasure from unusual sensitivity to experiences with music, language, art, and foods; experience these things so intensely that the world around them ceases to exist for a time

Overexcitabilities & Misdiagnosis not just limited to ADHD

Intellectual and psychomotor overexcitability could easily lead to the misdiagnosis of ADHD

Intensity sometimes leads to diagnosis of Oppositional Defiant Disorder

• Excitement about new information • Each curiosity leads to blurting out the answers in class • Asks questions may be appear to be irrelevant because he has been thinking of ways the information may apply in other situations • Foot jiggling or pencil tapping do not impair his learning but may impact others around him • Boredom because he already knows the material being taught, off task behavior may be evident too

• Intensity is sometimes played out in strong-willed behavior; longer attention spans, better concentration, motivation, tenacity; boundless enthusiasm appears eccentric, try to impose their opinions onto others • Angry power struggles

Some overexcitability behaviors could easily be misinterpreted as part of a diagnostic syndrome

Thinking and Learning Styles can Prompt Misdignosis

Auditory Sequential

Visual Spatial

Thinks primarily using words; learns phonics easily

Prefers auditory explanations

Thinks primarily in images and prefers seeing tasks demonstrated

Prefers visual explanations

Processes information and tasks sequentially

Prefers to learns facts and details; likes specific instructions

Processes information holistically; prefers seeing the overview prior to details

Prefers abstract thinking tasks; likes general goals and directions

[Adapted from Silverman, L. (2002) Upside brilliance: The visual-spatial learner. Denver, CO: Deleon Publishing]

Problems with Thinking Style: Visual-Spatial/Non-linear

Intensity when coupled with creative/messy learning style may lead to POWER STRUGGLES with adults who see the child as SCATTERBRAINED & Disorganized = UNACCEPTABLE Notâ&#x20AC;&#x201C;detail oriented; Unconcerned with completing tasks not of interest is likely to be labeled as UNDERACHIEVER/LAZY

Thinking is inventive, nontraditional which makes us uncomfortable and disrupts the status quo

VisualSpatial Non-linear

Thinking and Learning Style: Auditory Sequential/Linear

So serious and rule-bound they experience no joy or spontaneity

Take matters very seriously; coupled with intensity may take seriousness to the extreme

Seen by others as rigid, overly worried, or depressed Perfectionists

Auditory Sequential Linear

Evaluative

Idealism Can Prompt Misdiagnosis

Idealism combined with intensity = pain

Astute persons can envision how things out to be, but they can also see with equal clarity how things fall far below that standard. Inconsistency = pain

See hypocrisies and absurdities and the lack of logic around them

The intense, idealistic gifted individual who is misunderstood by parents, teachers, employers or coworkers is easily seen as overly sensitive, too serious, pessimistic, or possibly depressed

Sometimes these persons withdraw to live on the fringes of society or into a narrow private world.

Peer Relations/Asynchronous Development Point to Misdiagnosis

Peer Relations

Asynchronous Development

Judgment that Lags Behind Intellect Often Leads to Misdiagnosis

Behaviors reflecting good judgment stem from complex, unwritten rules about social behaviors

Error made by adults is to expect that a bright childâ&#x20AC;&#x2122;s social/emotional behavior will match his intellect; better judgment is expected from a gifted child than from another child at the same age

Judgment/ executive function is biologically driven and on a fixed timetable (planning, judgment, inhibition of impulse attention are the last parts of the brain to mature)

Intensity of gifted children can cause their intellectual curiosity to override their judgment

Judgment that Lags Behind Intellect Often Leads to Misdiagnosis

Creativity Can Cause Misdiagnosis

Educational Misplacement/Lack of Family Understanding ď&#x192; Misdiagnosis

Similarities & Differences: Gifted Children/Children with ADHD

Problems in School Settings ADHD: problems occur across all setting

ADHD: inattention and hyperactive children tend to be more aggressive, inconsistent with peers -> negative impact with peers

GT: problems occur in some settings

ADHD: forgot to do the work/inattentive to directions/ completed incorrectly/left it unfinished/lost it; may not even have paper or unable to complete lengthy assignments because there is no immediate consequence

GT: appear to be aggressive because they talk out more, correct/lecture others; frequently rejected by same-age peers

Problems in Completing/ Turning in Work

Rules & Traditions

GT: made a conscious choice to not complete the work as directed or simply decide not to turn it in; may choose to skip the first 25 of 50 problems

Incompatible or Contradictory Features (GT & ADHD)

Behavioral features that are incompatible with or contradictory to a diagnosis of ADHD in a child of high intellectual ability: Problems first occur when the child starts forma schooling Shows selective ability to attend to task that are of interest, with intentional withdrawal from tasks that are not of interest Has prolonged intense concentration on challenging tasks of interest with no readily-evident immediate reward Is unaware of environment when interested in a task Is easily distracted by environment when uninterested in a a taks, but tries to avoid disturbing others Delays response when spoken to, but gives thoughtful response Intentionally fails to finish tasks (especially rote work) Blurted answers are generally correct Interruptions of conversation are to correct mistakes of others Can be easily redirected from one activity of interest to another activity of equal interest Passes attention tests, and can shift attention readily, if motivated Returns to a task quickly after being distracted or called off task

THE BOTTOM LINE

THE BOTTOM LINE…. These questions need to be answered

Are the behaviors present in most or virtually all settings?

Is there great inconsistency in the quality of the child’s work in almost every setting?

Does the child’s behavior significantly change when the novelty of a situation wears off?

Is the child’s behavior improved when more structure is given?

When the child is interrupted, how rapidly is he able to return to ta task or able to shift tasks?

Can the child engage in solitary activity fro long periods of time quietly?

Before Referring a Gifted Child for ADD/ADHD Evaluation Lind, S. (1996). Before referring a gifted child for ADD/ADHD evaluation. Retrieved from http:// www.sengifted.org/archives/articles/before-referring-a-gifted-child-for-addadhd-evaluation GIFTED 1. Contact with intellectual peers diminishes inappropriate behavior 2. Appropriate academic placement diminishes inappropriate behavior

ADHD 1. Contact with intellectual peers has no positive effect on behavior 2. Appropriate academic placement has no positive effect on behavior

3. Curriculum modifications diminish inappropriate behaviors

3. Curricular modifications have no effect on behavior

4. The child has logical (to the child) explanations for

4. Child cannot explain inappropriate behavior

inappropriate behavior 5. When active, child enjoys the movement and does not feel out of control 6. Learning appropriate social skills has decreased “impulsive” or inappropriate behavior 7. Child has logical (to the child) explanation why 8. Child displays fewer inappropriate behaviors when interested in subject matter or project 9. Child displays fewer inappropriate behaviors when subject matter or project seems relevant or meaningful to the child 10.Child attributes excessive talking or interruptions on need to

5. Child feels out of control 6. Learning appropriate social skills has no decreased “impulsive” or inappropriate behavior 7. Child is unable to explain why tasks, activities are not completed 8. Child’s behaviors not influenced by his/her interest in the activity 9. Child’s behaviors do not diminish when subject matter o project seems relevant or meaningful to the child 10.Child cannot attribute excessive talking or interruptions to a need to learn or share information

share information, need to show that he/she knows the answer,

11.Child who seems inattentive is unable to repeat instructions

or need to solve a problem immediately

12.Child moves from task to tasks for no apparent reason

11.Child who seems inattentive can repeat instructions

13.Inappropriate behaviors persist regardless of subject matter

12.Child thrives on working on multiple tasks-gets more done,

14.Inappropriate behaviors persist regardless of teacher or

GT ADHD/GT ADHD Combined Type

Lovecky, D. (2004). Different minds: Gifted children with ADHD, Asperger Syndrome, and other learning deficits London: Jessica Kingsley Publishers., p. 6873.

have a much greater degree of variability on intellectual assessment

Class work of the is more variable that that of average children with ADHD

likely to have high-level functioning well above average, in at least one academic subject.

tend to be bigpicture thinking; they quickly grasp the concept, the endpoint, and the implications but do not complete rote work

require higherlevel work that points to a goal and that incorporates thinking and abstract reasoning.

differ from more average child with ADHD in the greater degree of uneven development or asynchrony they show in cognitive, social, and emotional areas

Show differences in social functioning; they have more specialized interests than average children with ADHD

Less efficient in their use of executive function skills than other gifted children

GT ADHD/Inattentive Type

Lovecky, D. (2004). Different minds: Gifted children with ADHD, Asperger Syndrome, and other learning deficits London: Jessica Kingsley Publishers., p. 74-77.

GT ADHD/ Executive Function

Lovecky, D. (2004). Different minds: Gifted children with ADHD, Asperger Syndrome, and other learning deficits London: Jessica Kingsley Publishers, p. 77-93.

Working memory

Internalization of speech

Deficits in arousal, activation, and effort

Difficulty being aroused and activated

Problems with sleep

Sensory overload

Sustaining effort on task

Holistic/sequential performance

Big Picture thinker

Difficulty with part-to-whole relationships

Prediction

Difficulty with demand performance

Emotional Control

Separating feelings from content

Sensitivity and intensity of emotion

Acting without thinking

Recognition of feelings and how they contribute to events

Ability to Delay Gratification

Sustaining attention without immediate rewards

Inability to feel rewarded by ordinary rewards

Slow work speed

Timing of behaviors

THE BOTTOM LINE

SERIOUS AND CREDIBLE RESEARCH IS NEEDED TO VALIDATE OUR CLINICAL OBSERVAITONS

Research Studies from the Medical Field

Antshel, K. (2008). Attention-deficit Hyperactivity Disorder in the context of a high intellectual quotient/giftedness. Developmental Disabilities Research Reviews, 14, 293-299.

Antshel, K., Faraone, S., Stallone, K., Nave, A., Kaufmann, F., Doyle, Al, Fried, R., Seidman, L., & Biederman, J. (2007). Is attention deficit hyperactivity disorder a valid diagnosis in the presence of high IQ? Results for MGH longitudinal family studies of ADHD, Journal of Child Psychology and Psychiatry, 48(7), 687-694.

• • • •

Massachusetts General Hospital Longitudinal Study

• • • • • •

Of the 525 children, 92 children (with IQ > 120) met criteria for ADHD Repeated grades more often Needed more academic supports Had more comorbid psychopathology • Over half had lifetime diagnosis of major depressive disorder • Over half met diagnostic criteria for oppositional defiant disorder • 35% had generalized anxiety disorder • 26% had separation disorder • 21% had social phobia • Rate of familial ADHD in first-degree relatives was similar to the rate of ADHD in average IQ Rated by parents as having more functional impairments across a number of domains Conclusion: Diagnosis remains a controversial one The disorder may be valid in the high IQ/gifted population as it is very similar to ADHD in the average IQ populations Stating that an individual with a high IQ and ADHD is substantially limited relative to their individuals with a high IQ is not adequate to demonstrate the prescience of a disability. ADHD may insulate adolescents from substance use and conduct disorders is intriguing yet requires replication At the primary and secondary school levels, educational implications for ADHD in the high IQ/gifted population are similar to ADHD in the average IQ Population.

Research from the Medical Field

Grizenko, N., Zhang, D., Polotskaia, A., & Joober, R. (2012). Efficacy of methylphenidate in ADHD children across the normal and the gifted intellectual spectrum. Journal of Canadian Academy of Adolescent Psychiatry, 21(4), 282-288.

Higher IQ children were found to present with less severe symptoms. No significant differences were found with regards to treatment response.

ADHD children within the normal and high IQ ranges all respond equally to psychostimulant treatment, and that proper medication management is necessary for all children with the disorder.

Research from the Medical Field

deZeeuw, P., Schnack, H., van Belle, J., Weusten, J., van Dijk, S., Langen, M., Brouwer, R., van England, H. & Durston, S. (2012). Differential brain development with low and high IW in Attention-Deficit/Hyperactivity Disorder. PLosONE 7(4), e35770

Research Studies from the Medical Field & Learning Disabilities Field

Kaplan, B., Crawford, S., Dewey, D., & Fisher, G. (2000) The IQs of children with ADHD are normally distributed. Journal of Learning Disabilities 33(5) 425-432.

Those who are gifted with ADHD

Lovecky, D. (2004). Different minds: Gifted children with ADHD, Asperger Syndrome, and other learning deficits London: Jessica Kingsley

Publishers.

GT ADHD/Positive Aspects

Lovecky, D. (2004). Different minds: Gifted children with ADHD, Asperger Syndrome, and other learning deficits London: Jessica Kingsley Publishers., p. 93-95.

 GT ADHD COMBINED TYPE  When motivated with interesting and stimulating work, perform quickly and produce work of outstanding quality  Creative ideas used in thinking talking, writing & visual and performing arts  Saw new connections and developed different ways of looking at things  Spontaneity allowed them to move past mistakes  Hunter Gatherer Types:  High energy, creativity, intuitiveness, resourcefulness, warm-heartedness, trusting attitude, ability to take risks, flexibility, good sense of humor, loyalty

 GT ADHD INATTENTIVE TYPE  Creativity and humor; appreciate more subtle types of jokes & sophisticated puns; sense of humor is offbeat, quirky, and can be on the dark side  When motivated they produce a great deal of work in areas in which they immerse themselves;  They can have startling insights into a subject area of people because they are often quiet observers  While they seem to be off in their own little worlds, they are taking it all in for later processing.  High ability to reflect carefully about the subject at hand; they are not quick to answer; can see all of the alternatives and can see ramifications others might not ever see  Tendency to be emotionally overwhelmed, but care deeply about things; passionate, need to know why bad things happen in the world  Ask disturbing moral and spiritual questions, and may not suffer fools gladly

Recommendations for Teachers & Parents

Cramond, B. (1995). The coincidence of attention deficit hyperactivity disorder and creativity. Storrs, CT: National Research Center of Gifted & Talented. When ADHD is suspected: 1.

Be open-minded to the possibility that difficult behaviors may be indicative of special abilities, such as creativity, as well as problems.

Become knowledgeable about the behavioral manifestations of creativity and ADHD throughout the life span.

Observe and record under what conditions the key behaviors are intensified or reduced.

Ask the child what she is thinking about right after a period of daydreaming.

If the child is referred for psychological screening: 9.

Whenever possible, choose a psychologist who is knowledgeable about giftedness and creativity as well as ADHD.

10. Be sure that a creativity test or checklist is completed in addition to the ADHD checklist.

If the child is diagnosed as having ADHD: 7. Get a second opinion 14. Be cautious about recommendations for the use of methylphenidates or other drugs.. 15. Be cautious about recommendations fro an unstimulating curriculum with lessons broken into small parts. 16. Provide opportunities both inside and outside of school to enhance creativity and build self-esteem.

IF YOU’RE SO SMART…..  WHY AREN’T YOU PERFECT IN EVERY WAY?  WHY ARE YOU SO STRESSED OUT?  WHY AREN’T YOUR RELATIONSHIPS PERFECT?  WHY CAN’T YOU EVER BE SATISFIED?  WHY DO YOU WEAR YOUR HEART ON YOUR SLEEVE?  WHY CAN’T YOU SIT STILL?  WHY ARE YOU SO FORGETFUL? CLUMSY? EMOTIONAL? IRRATIONAL?

 Just because you are gifted, it doesn’t mean you will be perfect, free from ADHD, OCD, anxiety or stress, have perfect relationships, be balanced in all aspects of your life.  But because you are gifted (have a high IQ) you or others will EXPECT your strengths to be stronger and more abundant and your weaknesses to be lesser and fewer.  This is the burden that teachers, parents, and counselors need to assist gifted kids in dealing with!!!!!

Some things in life just can't be explaine --Phenomenon, 1996

One can be just GIFTED One can be just ADHD One can be GIFTED/ADHD but either way, you can still change the world!!!!

References Antshel, K. (2008). Attention-deficit Hyperactivity Disorder in the context of a high intellectual quotient/giftedness. Developmental Disabilities Research Reviews, 14, 293-299

Barkley, R. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford Press.

Bartlett, J., & Kaplan, J. (1992). Familiar quotations (16th ed.). Boston, MA: Little, Brown, & Company.

Cramond, B.

(1995). The coincidence of attention deficit hyperactivity disorder and creativity. Storrs, CT: National Research Center of Gifted & Talented.

Kaplan, B., Crawford, S., Dewey, D., & Fisher, G. (2000) The IQs of children with ADHD are normally distributed. Journal of Learning Disabilities 33(5) 425-432.

Kaufmann, F., Kalbfleisch, J., & Castellanos, F. (2000). Attention-Deficit Disorders and gifted children: What do we really know? Storrs, CT: The National Research Center on the Gifted and Talented.

Kirk, S., Gallagher, J., Coleman, M., & Anastasiow, N. (2012). Educating exceptional children (13th ed.). Independence, KY: Cengage Learning.

Lind, S. (1996). Before referring a gifted child for ADD/ADHD evaluation. Retrieved from: http://www.sengifted.org/archives/articles/before-referring-a-gifted-child-for-addadhd-evaluation

Lovecky, D. (2004). Different minds: Gifted children with ADHD, Asperger Syndrome, and other learning deficits London: Jessica Kingsley Publishers

Radioguy. (2014, May 3). Phenomenon [Video file]. Retrieved from https://www.youtube.com/watch?v=MEoT3d0GrfM

Troxclair, D. (2002). ADHD, gifted, neither, or both? Reading: Exploration and Discovery, 24(1), 66-71.

Webb, J., & Latimer, D. (1993). ADHD and children who are gifted. Exceptional Children, 60(2), 183-184.