Misdiagnosis and Dual Diagnoses of Gifted Children and Adults
Webb, Amend, Webb, Goerss, Beljan and Olenchak
Great Potential Press
ISBN 0-910707-67-7
A team of three psychologists, two Ph.D.s and one M.D. examine
clinical experience with gifted people, especially
schoolchildren, and find that the diagnostic criteria in the
standard Diagnostic
and Statistical Manual (DSM-IV-TR) don't account for the
normal effects of abnormally high intelligence.
The book is both anecdotal and rigorous. Stories (often
heartbreaking) of gifted kids are used to illustrate detailed
checklists that explain when to reject a standard diagnosis.
The book should be useful both to parents and to professionals.
The writing style is clear with a minimum of jargon, but precise.
A few examples should give a feel for the content:
ADHD
One of the few places that DSM-IV-TR warns doctors to consider
the patient's intelligence is in the second on Attention
Deficit Hyperactivity Disorder. The child who is scattered,
inattentive, and possibly disruptive in class may simply be bored
out of her skull with the endless repetition of material she knew
to begin with. The authors give several ways to rule out a
diagnosis of ADHD, one of the simplest of which is to look at how
the child acts in quiet but interesting settings. A gifted child
will vanish into a book for hours: an ADHD child couldn't if
he tried.
Responding to Ritalin is not evidence in favor of an ADHD
diagnosis. It improves attention span and reduces motor activity
in almost everyone.
Asperger's
A lot of bright people feel awkward socially, miss social cues,
and excel at memorization. This may sound close to the definition
of Asperger's Disorder. It's not the same thing.
A person who relates well with others who share his interests,
who can function in new environments or new activities, and who
grasps abstractions and metaphors is a poor candidate for an
Asperger's diagnosis.
Disturbed relations with peer group
"A common feeling or fantasy among highly gifted children
is that they are like abandoned aliens waiting for the mother
ship to come and take them home"
The authors warn practitioners that "peer group" and
"age mates" are separate and possibly contradictory
classes.
The state of medical practice
Teachers and doctors may not have had any training in recognizing
or evaluating gifted children. The preface goes so far as to call
the result a "tragedy". One painful anecdote describes
a doctor telling a parent that they should just leave the
child's giftedness out of the equation. "Aside from
that, Mrs. Lincoln, how did you like the play?"
Parents and educators out there -- does this ring true in your
experience?
My youngest son tested in the 97-99% range on standardized tests and his IQ tested at 132. School was a nightmare for him and me both, he did not deal well with the other children, the teachers did not like him and he was as disorganized as it is possible to be (to others). I finally pulled him out of school in the eighth grade and home schooled him for the 2 years before he died. I was so grateful that I did home school him, he was happy for his last two years as opposed what he would have been had I left him in school. From my experience, the schools are organized to deal with the mentally handicapped and gifted children are largely disregarded. This is a tragedy because many gifted kids drop out of school out of frustration when if they been educated to their abilities, they would more than repay the extra expense and effort after they reach adulthood.
I'll start by extending my condolences. No parent should ever suffer the pain of outliving their offspring.
I would also like to share my experiences.
My first grade teacher said I had a 6th grade reading level, but I was first recognized as "gifted" in 3rd or 4th grade - My district had a "Gifted and Talented Education" (GATE) program, which helped increase the odds of you getting a competent teacher, but it also usually meant that you were to be inundated with larger amounts of homework - and harder material as well.
I didn't do well in either a standard classroom or a GATE classroom setting. In fact, Public School wasn't a very positive influence in my life at all. In 6th and 7th grade, I woke up wondering how many fights I would have to try to avoid that day (There's the old Japanese expression: "The nail that sticks up gets the hammer." And I was a 12-year-old boy with very long hair and androgynous looks. I dunno, maybe the way I looked backed then made other guys my age angry about questioning their own sexuality, red-neck hicks tend to make up the majority of my hometown's stock). But then I got into Charter School, which, for me, was a very good balance of Home School and Social setting. The first year I was in Charter school, my classroom was comprised of students from 4th-8th grade, and most of them were a lot sharper than the zombies that populated my Public school rooms.
I think there's a big problem with the way schools identify "gifted" students, and an even worse problem figuring out what to do with them once they have been identified.
When I went on to High School, I got lazy, and complacent. I just plain didn't care. I took the California High School Proficiency Exam pretty much just stopped going to class once the positive results of my test came back half-way through my Junior year (boy, the school administration sure loved that).
Shrinks are just one part of a complex problem. "Discipline and Punish" or "Madness and Civilization", anyone?
F'ed up parents bring their bright but misbehaving kid to an incompetent shrink who unleashes all manner of institutional crap on the kid from segregation, to drugging, to labeling, and so forth. Horrific enough, though it serves its social function of containing and utilizing the kid's maladjustment to better secure the position of elites. Yes, that's bad enough -- and well enough present in the press as, for example, stories about the overmedicalization of kids. But, that's hardly the end of it.
As with prisons and random searches in TSA lines at the airport, the stories of such abuses serve as warnings and as a hegemony that spreads beyond the specific institutional practices referred to. It serves, like random searches and arrests, as a warning so that, everywhere, many parents, educators, and others with power over children then become guards in the extended panopticon -- monitoring their kids for signs that they are at risk for such treatment and doing whatever is in their power to channel their kids in more acceptable directions.
It doesn't stop with children, either. What is, in the unenfranchised child, an attitude problem is, in the worker, reasons for dismissal or worse. What you are looking at, here, is not simply the medicalization of intelligence but the medicalization of dissent.
-t
p.s.: 132 ain't much -- not that the tests are all that meaningful, imo. My childhood tests came out around 30% higher and I'm quite sure that nothing good ever came of that.
(I meant to add: nothing good ever came of that other than, perhaps, that I get to say that many of the smartest people I've met would certainly score quite low on these tests. And no, I don't mean "smartest" in a Chauncy Gardner sense -- I mean whip smart, wasted, best minds of my generation.....)
It used to be taken for granted that people could have wildly different personalities. A hundred years ago we could accept that one person was going to spend their life breaking horses or guiding people up and down mountains, while another would sit in an office copying documents or calculating sums of numbers.
No we are all expected to go to school for the same number or years, learn the same stuff and not deviate from the norm by too much.
I don't know about being gifted. Many people are good at a few things. A stereotypical mass murderer might be a hero during war time.
I think conformity is going to continue getting worse on Earth, but there will eventually be places to escape to in the wider universe. I dont think we are heading for THX1138 everywhere.
Ah yes, the diagnostic category of "Oppositional Defiant Disorder". It's a real diagnosis in DSM-IV. The authors of "Misdiagnosis" point out that it's a lousy description of someone who argues by reason, defies some adults but obeys others, and shows concern for other people's feelings.
The important questions are: (1) Can someone patent a medication that produces positive clinical results among ODD sufferers in a 3 year study? (2) Does it simplify the administration of a school to train teachers and managers to identify potential sufferers and insist they be routed through an evaluation process?
If "yes" and "yes" then, no problem, we can concoct all manner of BS talking points about how ODD costs USian businesses $X per year, results in a higher divorce rate .... whatever.
Better living through better chemistry pharmacology,
-t
Agreed, when I was a teen I aced them all which meant that I was off the charts for my age range at the time, but as an adult I tend to come in at the mid to upper 90s percentile-wise. Conversely I know at least a few people who tested quite average as teens and now score in the 90s as well.
Testing during the school years really only identifies the child's abilties in that context at that point in time and really has little bearing on their potential or what might actually be an appropriate learning environment.
The 'modern' school system evolved to create good factory workers that could read and stand in line. Since the workforce has changed dramatically, education needs to change as well.
Nowadays, we don't need more conformity, we need more new radical ideas. Nowadays, real wealth gets created by ideas that can be implemented in surprisingly short periods of time. With a good idea and a strong work ethic, you can become a millionaire in 5-10 years. But people who do this are not those who just stand in line and know how to read.
The public fool system didn't earn its nickname without cause.
Been there, done that! I've got a Ph.D in physics, breezed into Mensa, and usually score a comfortably High I.Q. (and smart enough to know that past a given threshold, such a number means nothing). I'm also rather learning disabled with terrible coordination, motor skills and a severe speech defect (the latter I was able train around in my teens).
This led to me being classified as EMH (educably mentally handicapped), basically just good enough for drudge work. I've been classified as hyperactive as well. Aspergers wasn't a common diagnosis at that time so I missed that. The other kids were too busy beating the crap out of me to observe my relations with my peer group. When I had enough language skills (even then I was a massive bibliophile) I went through a round of testing at a university medical center. While we were alone in a room waiting for a test, my mom thumbed through my file, turned pale and got me the hell out of there. They were settling on a classification of borderline psychotic!
With a lot of help from my parents, the ACLD and gifted child groups, I made it through grammar school. While high school was a struggle, I got into a magnet school and started to rise once the emphasis wasn't on physical ability and rote memorization. By college things went very well and I have a good life now.
As for feeling like an alien, I always identified with Spock. But what was most striking was that I have just finished off The Melancholy of Haruhi Suzumiyaand really identified with it!
Wow, this really rings a bell. I had a terrible time in school. Recently, our son tested around 130-something (99th in verbal, less on the speed-testing parts) for the only "gifted" school within 50 miles (and I live in Silicon Valley!) When it came to the interview, they stuck 20 noisy kids who didn't know each other in a room. He "failed" the interview because he didn't want to play and interact.
In my own case, I recall my mom taking me around to private schools in 3rd grade because I was so miserable in public. The only one I got into was a sort of parochial, blazers + chapel in the morning preppy place (John & Patrick McEnroe went there). It wasn't any better. Fortunately, I predated all these diagnoses; I was just a problem child.
My perception is that education professionals are trained to think about bringing up the bottom 20% rather than caring about top performers. The attitude is that much of this is background (rich, caring parents = kids who seem smarter), and if you're in that class, you'll do well in the world regardless; their mandate is to keep the poor performers (with crappy home lives for the most part) from dropping out and becoming a burden to society. There is a pretty significant collectivist/socialist POV in education and academia; anything that smacks of Ayn Rand-ish elitism is seriously frowned upon. I think this explains the lack of GATE attention, at least in the public sector. Even in the world of private schools, if you're a well-heeled donor, it's much hipper to tell ppl at parties that you're helping the poor and underserved, rather than you're giving your money to an institution that caters to elite upper-middle-class whites & asians who think they're better than everyone else (satire!). The local gifted school has struggled with funding for years, and exists largely due to the gifts of a single family and a few well-off parents (which of course makes it almost impossible to get in if you're not part of that social circle; 15 spots a year for all of Silicon Valley???)
As a Family therapist who works exclusively with the gifted population either in groups or individually, this problem of misdiagnosis is widespread. I have consulted internationally, and many of my clients drive at least an hour to see me, just because they can trust that I won't pathologize the experience of the gifted (as has happened in the past.) In particular, parents of children who fall in the profoundly gifted category are faced with huge challenges when trying to meet the multi-aged needs of these children. It is normal for a child to have asynchronous development: they might have been born nine years earlier, but their intellectual age might be closer to 29; their emotional age, or maturity level might be advanced in some situations, but trigger their injustice button and them might act like a two year old with a tantrum. Socially they may be aware and conscious or live in a fantasy world like Walter Mitty. All of the above is NORMAL for this population. Yet over and over again I hear that children are being threatened with being held back for "emotional immaturity" which really means high sensitivity and abnormally ethical values, for their chronological age.
Both the Misdiagnosed Child, and The Eide's book on Dual Diagnoses are invaluable resources for any parent is faced with a questionable diagnosis when comparing it with what they know to be true about their child.
Linda Powers Leviton MA MFT
West Coast Director of the Gifted Deveopment Center
Those of us who are educators passionate about the education and social/emotional development of the gifted, find a common struggle to inform our colleagues about the needs of gifted children. Most teachers do want to provide the appropriate education for all children, but lack the knowledge and skills to provide for the gifted. As a nation, we do not value giftedness. Rather we see it as elitist and snobbish. The federal government allocates little money to states for the education of gifted children and most states spend a fraction of the total educational funding on gifted education. In California districts receive about 0.2% of the total state educational budget for gifted education. We are so busy bringing up the bottom low achieving students (a noble cause, nonetheless) that we fail to spend any time or money on the gifted.
When students are gifted and also struggle with ADHD, Asperger's or other exceptionalities, the challenge is even greater to be understood. The answer lies in educating the educators and in educating the public about the needs and challenges of being gifted. I teach one of five courses offered through a GATE Certificate Program in Northern California. When the certificate is completed, teachers thank us for the knowledge they have gained through the coursework. They change their whole thinking about gifted children and the educational needs of gifted children.
I applaud the school districts who realize that there is a need for such programs for teachers. Those districts are few and far between. We can only make an effort district by district to inform educators. Pray that any funding is available in states to continue this district by district effort.
Dr. Barbara L. Branch
Branch Consulting (A Resource in Gifted Education) and Chair of the Capitol Region GATE Consortium
Yes. I can tell from personal experience exactly just that.
The gifted child grows up in the cradle of surpassing expansive awareness and deep intrinsic emotions. He hears, really hears, the bubbling spring and sees, really sees, the liquid light at dawn, while others merely take life for granted. Loneliness and giftedness are as inseparable as the ocean and its waves. The gifted person is capable of very high dreams and extreme nightmares because life before him is naked. He sees the Void behind the rest and motion of things. What a silent life he lives amidst the clamor of the world. The silence, the emptiness, he perceives in things often yields him to anxiety's shore. But that's his only dear friend. At the same time, it is a source of endless creativity. He sees things with the perfection of the intellect coupled with emotional instability and so he knows both the depth and fragility of beauty. He moves between love and sorrow to the extent that his joy is sorrowful and his sorrow is joyful. His intrinsic emotional instability is none of his fault. To him, life is very much inconsistent. So inconsistency is the only consistent thing in the world. This is but his personal access to originality. This way, he discovers a whole new world everyday. To him, the greatest tragedy of life is being unoriginal, static.
Yet all that isn't enough... The gifted is able to move with the weeping and laughing seasons and think really deep with them, but who understands his hunger for something brighter than the sun and more spectacular than the meteor in the night sky? His song is that which only silence can understand. Nobody understands him. To him, simply living in the society and being its normative puppet is death approaching aimlessly. This is because life needs to be constantly revived on a finer level. He has very deep concern for the problems of the world: when someone dies of injustice, a part of him dies. But at the same time he sees his own limitations and that brings him to the realization that "If this life assailed by many ills is yet more fragile than a bubble on a stream, how wonderful it is to either wake up from this deep sleep and breathe in life's everlasting breath or simply vanish into the void of nowhere!"
Embedded in the inevitable superficiality of his society while at the same time living in his own universe of pure awareness (whose depths are immeasurable by any standard) which he has built with the hands of imagination and constant reflection, he feels helpless like melting ice. "I don't know if I exist or not." Questions such as "Why am I here at all?" do make the ancient strings in his mind quiver but basically they just send him into a strange suffering. Ordinary people usually pity his loneliness and lethargy and he says to himself: "Ok, I take it as a curse." His restless sharp mind and deeply sensitive heart often feel like strangers even to himself. Yet these two are dearer to him than anything else. "Oh I have seen this stranger over a thousand times, I am but a faceless wanderer each day."
What mind is there behind giftedness? It is not known except that it is a flame born in loneliness as the child of silence. All I can say is that such a mind finds both freedom in loneliness and the safety from being understood by people, "for those who understand us, usually enslave something in us."
I'm now in my late teens, still standing like a trembling shadow before the sun. I still dream of the stars beyond our nights. I can never finish marveling, hearing and feeling. I still feel so cut off from the rest of creation yet I remain in union with that which moves life in secret.
I have never heard anyone describe my perception of life so well. I guess that is reality for me after all. I thought that I was psycotic. I have major issues in life so I thought that there is no way I could be gifted because I do things that are really stupid sometimes. Well, they seem stupid anyways. I think that I make life more complex than it really is. Or, maybe life is that complex and I just know it, or maybe life is purposefully complex to inspire and instagate movement throughout it's existence. As though it's very purpose is to cause and effect so that life continues on. Perhaps without the paradox, there would be nothing. On the other hand I seriously doubt this as a person with little cognitive awareness still exists. Sometimes I would like to rip my brain out then I feel guilty because I need to be nice to myself. Although I see my brain as a separate entity altogether. Either way I should not be mean to it. I am frustrated because noone gets me. I am relieved to hear that I am not alone after all. Though the loneliness and silence continue on to create seemingly endless galaxies between me and you and everyone, gramatically correct or not. Organized or scattered. Life is a broken mirror reflecting back and magnifying every sound, moment, thought, feeling, sensation at me. I hover above the shattered peices thinking that if I can just put the mirror back togther that things will make sense and be okay. I am left wondering.........always.
Thank you for the reply to my sentimental message : )...
I assure you, you are not alone in this seemingly infinite dark space of existence whose shadows move at a frightening pace.
What world do minds like us live in? We both know that it is a world at the extreme end of a spectrum of all possible realities. Often to me, simply being here is very humiliating... Mostly it's about primitive adventures deeply rooted in boredom. I sometimes think of filling the spaces of my aloneness, but actually not with the kind of "fillings" people take for granted. Often, I desire an outlet to a boundless Sea but instead I am trapped in a shallow, narrow pond. Some years ago I really struggled to the point of numbness to create something. This transitional period between infancy, youth, and adulthood with all its heaviness upon my soul was the most difficult part of my life as I struggled to transform myself from an avid thinker into a truly creative being. This was when I kissed the core of my anxiety and welcomed it as part of myself no matter how tormenting it was.
At that time, no one was willing to understand or help me in anyway (oh what a lonely world it was), which is why I am beyond happy whenever I'm be able to help like-minded person like you simply by gaining access to her inner, silent, distant world. Come what may, let it rain. Let it rain and let the rain kiss the soil of our hearts. I know no other way than this...
I somehow survived my formative period, which was teeming with tempests. And here I am now...
We, you and I, are not alone, Nicole.
Remember also that at the other end, opposite to ours, there are those with miniscule intelligence. It seems that evolution proceeds only at a glacial pace in their world. A silent world almost completely devoid of the high tides that normally carry the resonance of our thoughts and allow us to be appreciated by our own kind. It is not even a neurotic or psychotic world... It is like a black hole, an event horizon, in the fabric of life, where strangeness is lost in its most primitive, and yet most incomprehensible form, because, unlike the world of the neurotic or the psychotic, and unlike the world of the psychopath, it seems to be completely divorced from the integral functioning of the senses. A place where love, even love, is often not welcome and communication is lost in anonymity... It is a faceless, echoless existence whose shadow is displayed before us, "intelligent beings", like a dark abyss of unknown depth. I'm helpless about this at the moment. After all, we cannot always expect the world to be a smooth continuum of evolutionary processes. There are what mathematicians call "jump discontinuities" in it.
You're not alone, my friend. Whenever your life feels wingless and songless, please do not hesitate to write to me at
wings.of.solitude@gmail.com
And we shall give it a song and a wing woven by the music of pure emotions and imaginations.
I cannot promise to make you smile, but I can cry with you at the heart of our existential reality itself.
My son spent his elementary
years coasting along without having to do anything to keep up
with the class. Even after he was identified as gifted, no
special study program were ever provided, only a different level
of workload and expectations.
Once in middle
school, he developed attitude problems due to boredom and (I
think) intellectual arrogance on his part. He always felt
that his teachers didn't know as much as he did. Many
times, I believe that was true, which doesn't excuse his
disruptive behavior, but the school only treated the problem with
disciplinary action. I am not convinced that was the
right approach, but I don't have any idea
what they should have done.
He still had to
do little to keep up, and he never developed any study skills or
desire to do much reading or exploration outside the
classroom. SO now, I have a mentally gifted, academically
handicapped, disruptive class-clown on my hands, and I don't
know what to do to help him. If it keeps up this way,
he'll fail high school despite testing off the charts and
being quite capable of achieving more. I could use some
intelligent feedback.
Crazy, or just gifted?
Misdiagnosis and Dual Diagnoses of Gifted Children and Adults argues that school psychiatrists and other doctors start giving wrong answers when faced with a gifted person more than two or three standard deviations away from the norm.
Misdiagnosis and Dual Diagnoses of Gifted Children and Adults
Webb, Amend, Webb, Goerss, Beljan and Olenchak
Great Potential Press
ISBN 0-910707-67-7
A team of three psychologists, two Ph.D.s and one M.D. examine clinical experience with gifted people, especially schoolchildren, and find that the diagnostic criteria in the standard Diagnostic and Statistical Manual (DSM-IV-TR) don't account for the normal effects of abnormally high intelligence.
The book is both anecdotal and rigorous. Stories (often heartbreaking) of gifted kids are used to illustrate detailed checklists that explain when to reject a standard diagnosis.
The book should be useful both to parents and to professionals. The writing style is clear with a minimum of jargon, but precise.
A few examples should give a feel for the content:
ADHD
One of the few places that DSM-IV-TR warns doctors to consider the patient's intelligence is in the second on Attention Deficit Hyperactivity Disorder. The child who is scattered, inattentive, and possibly disruptive in class may simply be bored out of her skull with the endless repetition of material she knew to begin with. The authors give several ways to rule out a diagnosis of ADHD, one of the simplest of which is to look at how the child acts in quiet but interesting settings. A gifted child will vanish into a book for hours: an ADHD child couldn't if he tried.
Responding to Ritalin is not evidence in favor of an ADHD diagnosis. It improves attention span and reduces motor activity in almost everyone.
Asperger's
A lot of bright people feel awkward socially, miss social cues, and excel at memorization. This may sound close to the definition of Asperger's Disorder. It's not the same thing.
A person who relates well with others who share his interests, who can function in new environments or new activities, and who grasps abstractions and metaphors is a poor candidate for an Asperger's diagnosis.
Disturbed relations with peer group
The authors warn practitioners that "peer group" and "age mates" are separate and possibly contradictory classes.
The state of medical practice
Teachers and doctors may not have had any training in recognizing or evaluating gifted children. The preface goes so far as to call the result a "tragedy". One painful anecdote describes a doctor telling a parent that they should just leave the child's giftedness out of the equation. "Aside from that, Mrs. Lincoln, how did you like the play?"
Parents and educators out there -- does this ring true in your experience?