When Your Child’s Exceptionality is Emotional: Looking Beyond Psychiatric Diagnosis
by Barbara Probst
When people think of a twice-exceptional child, they usually think of someone who’s gifted and learning-disabled. The “second exceptionality” is typically an educational issue like dyslexia, or sometimes a physiological issue like sensory integration dysfunction. In other cases, however, a child’s second condition is said to be emotional, social, or behavioral. These are the children described as hard-to-manage, badly behaved, or just plain odd – despite, or perhaps because of, their high intelligence. They may even receive psychiatric diagnoses like Attention Deficit/Hyperactivity Disorder (AD/HD), Asperger Syndrome, or Bipolar Disorder. But do these difficulties merit psychiatric diagnoses? Are they disorders, or are they misunderstood and mismanaged aspects of giftedness? Perhaps your child does have a serious emotional disorder; if that’s so, then minimizing the problem may prevent him from receiving much-needed help. On the other hand, perhaps your child’s differentness has been pathologized – that is, turned into a disease; in that case, he may suffer unnecessary damage in the effort to fix what isn’t really broken. As a caring and concerned parent, how can you tell which it is? How can you distinguish difference from disorder, especially in gifted youngsters?
To explore that question, we’ll examine aspects of giftedness such as Dabrowski’s five overexcitabilities; explore how traits of temperament, as they manifest in gifted children, can lead to social and emotional difficulties; deconstruct some common diagnoses to see how difference is turned into disorder; and suggest strategies to reduce emotional overload and bring problems to a sub-threshold or manageable level.
Kazimierz Dabrowski, a Polish psychologist and psychiatrist writing in the 1960s, developed a theory he believed could explain the intensity, sensitivity, and unusual behavior of gifted individuals. He identified five overexcitabilities – heightened responsiveness to specific kinds of stimuli – that he felt characterized gifted children and influenced their behavior. Though not widely known, his theory is worth examining because it can shed light on how giftedness interacts with, or is transformed into, disorder. These overexcitabilities follow.
1. Psychomotor. In Dabrowski’s model, this is more than just an abundance of large-muscle physical activity. A child might not race from room to room or jump on furniture, but express psychomotor excitability by rapid speech, nervous habits, restlessness, and difficulty quieting his mind in order to sleep. Like every excitability, this isn’t necessarily something negative; it can also be the source of a child’s boundless energy and stamina. Often, however, a gifted child with psychomotor overexcitability is mislabeled with AD/HD.
2. Sensual. Heightened sensitivity to sound, light, touch, texture, or smell can also be viewed in two ways: as a difficulty (the excessive sensitivity associated with Sensory Integration Dysfunction) or as the capacity for esthetic appreciation. In a supportive context, a child with sensual overexcitability may find a life of passion and artistic engagement. In an environment lacking sufficient stimulation or, conversely, with too much competing stimulation, the same child may become anxious, irritable, withdrawn, or even explosive. The mismatch between temperament and environment is the source of the difficulty – not an inherent defect in the child.
3. Emotional. Once again, this overexcitability can be easily misunderstood. The emotional instability of a child with intense highs and lows may be seen as evidence of immaturity, bad upbringing, or even a serious mood disorder – but it might be none of these. In particular, adults need to be very cautious before assuming that emotional swings represent a psychiatric condition like Bipolar Disorder. With emotional overexcitability, there’s a greater responsiveness to actual stimuli (including thoughts and memories); even if the responses seem excessive, they’re responses. With a condition like Bipolar Disorder, on the other hand, the emotional swings follow their own rhythm and aren’t always connected to objective events.
4. Imaginational. This overexcitability is characterized by vivid dreams, creativity, love of fantasy, and inventiveness. Here, too, traits that might seem indicative of AD/HD or even a delusional disorder (requiring treatment) can also be seen as talents (requiring expression). Gifted children who become lost in a fantasy world or insist on peculiar interpretations may become poets, artists, or inventors. If outlets for expression are denied, however, they may develop problems like anger or depression.
5. Intellectual. Dabrowski’s fifth category is the one most typically associated with giftedness – an insatiable appetite for questioning, discovery, finding answers, and solving puzzles. Such children can seem annoying or arrogant, and their stubborn individuality can be misperceived as defiance toward authority or indifference to social context. They may be caricatured as “little professors” or, if their intellectual drive is focused on a narrow or esoteric subject, labeled with Asperger Syndrome.
While Dabrowski’s theory of overexcitability hasn’t been subjected to rigorous study, it does present an intriguing approach and raises important questions about the origin of emotional disorders in gifted children. Identification of the specific overexcitability at the root of a child’s behavior can be a productive first step.
Traits of Temperament
Another useful framework for understanding the behavior of gifted children is temperament. Temperamental traits are found in everyone, of course, but can manifest in particular ways in gifted individuals. If these traits are misinterpreted (e.g., if a highly idealistic child is rebuked for being “critical”), two kinds of problems can result. First, the child may receive pejorative labels because adults assume that the behavior reflects an anti-social motive or even a pathological origin; and second, other problems like anger, withdrawal, or low self-worth can result. After all, who wouldn’t become upset in the face of chronic misunderstanding, frustration, criticism, and isolation?
Traits of temperament that may contribute to emotional or behavioral problems include:
Introversion. Unlike the general population, the majority of gifted children are introverts who need to pull back in order to refuel. Gifted children who need to be alone to recharge may be misinterpreted as excessively self-preoccupied (narcissistic), timid, or socially backward.
Intensity. Gifted children may crave high arousal (intellectual and/or emotional) and require constant exposure to new stimuli, traits that can be mistaken for symptoms of AD/HD. They may feel passionately about areas of interest, take everything personally, and have strong opinions and intense reactions to events that others consider minor.
Concentration. Some gifted children tend to hyper-focus and prefer intense involvement with a single topic for a long period of time. Others, on the contrary, have a highly divergent style, need a wide lens, and are able to keep many elements in view at same time, even though other people may not see the connection and may assume the child has become distracted or “off-task.” The first kind of child is seen as concentrating too much; the second as concentrating too little.
Sensitivity. Here, too, gifted children tend to extremes. Some are easily moved by anything that seems “unfair” and will empathize to the point of over-personalizing, even identifying with large-scale events like war or hurricane. Broken promises and small slights can be deeply upsetting, and these children may have difficulty discriminating. Alternatively, some can focus on more abstract patterns or possibilities, appearing remote and insensitive.
Adaptability. Children with a fiercely independent sense of their own vision may insist on completing what they started in the way they imagined, regardless of adult attempts to reason, cajole, or threaten. Flexibility and compromise are considered the abandonment of their vision, and requests to stop before completing their mission are seen as arbitrary and unreasonable. In a culture where “being a team player” is highly valued, gifted children may thus be pegged as rigid, arrogant, controlling, and intolerant.
Perfectionism. Perfectionism is a feature of many gifted youngsters and, like over-excitability, has two aspects. On the one hand, perfectionists are motivated to work toward quality and mastery, and they derive pleasure from achievement. On the other hand, they can be stubborn, critical, and easily side-tracked by a tendency to split hairs and miss the larger picture. They may insist that something be done perfectly the first time (unrealistic expectations) or, on the contrary, continue to redo a task long after it’s reasonable to move on because it’s still not “right” (perseveration).
How these “Traits” Become “Problems”
No trait is inherently difficult; but in combination and through interaction with elements of the environment (other people, timetables, sensory features), traits can lead to behavioral problems, including:
Difficulty with peer relations. Idealism, a heightened awareness of hypocrisy, unusual interests, and asynchronous development (when a child is mature in some areas, such as intellectual reasoning, but immature in others) can cause difficulty making and keeping friends. Unusual sensitivity can make a child vulnerable to perceived rejection; she may feel betrayed by a peer who plays with her today and with someone else tomorrow, referring to both as “friends.” In other cases, gifted children who like to organize others or insist on rigid adherence to rules can have trouble with the give-and-take of social relationships. Unable to find the deep friendships she envisions, a child may invent imaginary friends or make do with stuffed animals, pets, or characters from video games.
Like all children, gifted children do want friends and may thus be caught between two contradictory desires: the desire for affiliation (belonging, connectedness) and the desire for integrity (being true to oneself). The experience of contradiction in itself can cause stress and lead to feelings of wariness and isolation; and it can be further compounded when a child’s tempo is different from his peers’. Gifted children often have extreme tempos, either exceptionally slow (needing time to ponder) or exceptionally fast (arriving at connections and conclusions long before their companions).
Difficulty making decisions. Gifted children, particularly if they’re divergent thinkers, may see so many sides of an issue, so many what-if’s and possible outcomes, that they become overwhelmed. Unable to manage the richness that floods their minds, unable to bear the contradictions and sense of loss about all the roads not taken, they’re unable to act. A child who can’t pick a dessert because she’s acutely aware of all the desserts she won’t be getting if she chooses apple pie – and who tantrums when adults urge her to hurry – may be seen as demanding and spoiled when her behavior is actually due to cognitive overload.
Excessive self-criticism. Perfectionism and high standards can lead to self-criticism when gifted children berate themselves for falling short of their ideal. Frustration may be coupled with resentment about high performance expectations imposed by others. Angry and aggressive reactions may be directed at themselves, at adults whom they blame, or at scapegoats like younger siblings.
Avoidance of risk-taking. Intolerance for imperfection can cause children to avoid activities if they aren’t sure they can perform to their own standard. Just as gifted children may see myriad possibilities and become paralyzed by mental overload, they may also see myriad potential problems and become paralyzed by anxiety. Fear of failure – unwillingness to take risks – can lead to feelings of unworthiness, defensiveness, and underachievement.
How these “Problems” Become Symptoms and Diagnoses
There are three ways to view so-called “disorders” like hyperactivity, anxiety, or depression. First, we can think of them as neurobiological conditions, hardwired into brain structure or genetics and, therefore, just as primary as height or skin color. From that point of view, they can’t be prevented, though they can be managed more or less well; a gifted child might thus receive a dual diagnosis such as gifted and AD/HD.
We can also think of them as secondary conditions that develop as a result of continual stress. In that case, they’re still real but not necessarily biochemical, and the idea of dual diagnosis holds.
Then there’s a third possibility – that these aren’t disorders at all but misinterpretations of traits that only seem problematic because of context or value system. From that perspective, it’s a matter of misdiagnosis. For parents of twice-exceptional children, the questions are: which is it, and how can we know?
Clearly there are children with true psychiatric conditions. Children who hurt themselves, exhibit dramatic change in eating or sleeping, or talk about suicide need immediate professional help. But in many cases psychiatric diagnoses are given to behaviors that stem from unusual intensity, sensitivity, or eccentricity and aren’t pathological at all. We need to de-construct some of the common diagnoses to see how misdiagnosis can occur.
Attention-Deficit/Hyperactivity Disorder (AD/HD). Divergent thinkers who enjoy pursuing tangents and making unusual connections are apt to be called impulsive and distractible – and diagnosed with AD/HD. Other children who become absorbed in their own thoughts and seem to “space out” are labeled ADD (without the hyperactivity). In both cases, however, symptoms of the disorder are also characteristics of giftedness. Without an objective test for AD/HD like we have for AIDS or diabetes, it’s dangerous to assume these are indications of neurological dysfunction. After all, a symptom list is only a collection of descriptive (not causal) observations, shaped by value judgments about what’s desirable and what’s not. In a culture that values boldness and innovation (as we claim to but don’t, not when it comes to children), a quiet child who sits still without straying from the task could just as easily be diagnosed with Attention Surplus/Hypo-Activity Disorder.
Oppositional Defiant Disorder. Many gifted children have a strong sense of self; they don’t automatically respect adult authority figures and may challenge rules that seem (to them) arbitrary or illogical. But that doesn’t mean they’re pathologically defiant. Arguing or refusing to comply with requests can be an expression of independence, not an act of spite.
Depression. Sadness can be a response to loss of the familiar, especially at a time of developmental transition, or to alienation from peers (feeling lonely, left out, and different). Children who feel sure they’ll always fall short, or who feel caught in a situation over which they have no control, may become subdued and withdrawn. In all these instances, however, it’s the child’s situation that has to change, not his response. “Treating” the depression instead of trying to improve the environment is like trying to stop a leaking roof by mopping the floor. Gifted children can also experience “existential depression” when they become occupied with questions of existence or become distressed by the gap between the perfect world in their mind and the real world around them.
Bipolar Disorder. A gifted child can have intense emotions without having Bipolar Disorder. Sometimes emotionality comes from asynchrony in the child’s giftedness – when her awareness of loss, pain, peril, or joy exceeds her ability to integrate and manage what she feels. Sometimes adults assume – incorrectly – that the child’s reaction came “from nowhere” without understanding the child’s vulnerability and sensitivity. In fact, there’s no objective measure of when an emotion is too large, lasts too long, or shifts too abruptly; what’s “moody” in one family is “full of life” in another.
Anxiety Disorder. Worry, like sadness, can be a child’s response to his perceptions about life. When a gifted child sees what might happen but lacks the means to influence outcome, the feeling of helplessness can be acute. Adult evasions and assurances only increase anxiety in a child whose mind has leapt to everything that might have been left unsaid.
Asperger Syndrome. Just because a child is deeply involved in a narrow topic and not interested in typical social interactions, it doesn’t mean he belongs on the autism spectrum! Asperger’s has become a convenient label for children who are smart but odd. Sometimes parents will say, “My child has Asperger’s even though he can still be affectionate, imaginative, and funny when he’s at home.” If that’s true, then it isn’t Asperger’s. Like depression, the diagnosis of Asperger Syndrome should be reserved for the children who truly merit it.
Strategies to Reverse Direction
Instead of turning every difficulty into a diagnosis, we need to go in reverse and reclaim normalcy as a spectrum condition. To do that in a way that’s more than semantic, we need to learn how to reduce a child’s distress or frustration to a manageable (sub-threshold) level of difference. Here are some ways to do that.
Modify the environment to reduce the overall stress level. Children need to operate at a level of stress that’s below what they can reasonably tolerate. Without a “margin of tolerance,” there’s no room for a child to absorb and cope with the additional stress that will inevitably occur; and something is bound to happen to tip an excitable 2e child into the melt-down zone. The parents’ job is to increase that margin by eliminating unnecessary obstacles and stressors. We need to think broadly and creatively about elements of context that may matter for a particular child and about which we’re willing to be flexible. Included might be sensory elements, demands about time (tempo, duration, and schedules), and conceptions of space. Some children do much better in large open spaces and feel boxed-in when the space is too small; others need the containment and coziness of small spaces in order to feel grounded.
Use language that normalizes and emphasizes common human struggles. Help your child isolate and normalize her area of difficulty. “You’re the kind of person who … hates to be interrupted, likes things to stay the same, needs time to figure out where to start.“ That tells her she isn’t the only one who’s ever felt this way or struggled with these issues. Where possible, reframe “problems” into neutral traits. “Picky” can become “You definitely know what you like.” “Stubborn” can become “You’re not a quitter.” “Impulsive” can become “You aren’t afraid to try something new.”
Show that you ”get it.” Don’t try to convince your child that he doesn’t feel what he feels. You may be right that someone’s failure to keep a promise isn’t the end of the world, but telling your child it’s “not a big deal” doesn’t help him calm down – it just proves you don’t understand. If your child insists that you don’t understand, you probably don’t. Sometimes parents and children are talking about two different subjects – your child wants you to acknowledge what might have happened, while you keep insisting that it didn’t. He knows his sister didn’t actually break his Lego castle, but he wants his concern to be taken seriously.
Help your child externalize what is occupying him internally. Activities like drawing, recording an audiotape, or writing a letter to the editor can help your child give form to intense feelings. Externalizing can also help him organize the ideas that are flooding his mind. If, for instance, you want your child to select a toy for his birthday but he can’t handle the flood of too many possibilities, help him create a grid or matrix to organize the choices according to whatever dimension seems important to him – novelty, popularity, durability. If he’s pressured to select a gift without having worked through all the pros and cons to his own satisfaction, reaction is inevitable: he’ll reject the toy and then you’ll get angry at his ingratitude.
Practice ahead of time. Once the meltdown has started, it’s too late. If your perfectionist child has rejected the vanilla ice cream cone because it has a smear of chocolate, your chance of convincing her that it’s okay is much greater if you’ve talked ahead of time about the 5 percent rule in statistics. (Statisticians are only concerned with arriving at 95 percent probability, because you can never account for every potential case.) You can remind your child that a cone counts as vanilla as long as the chocolate smear is less than or equal to 5 percent – but you can’t pull that idea out of a hat once she’s in the midst of a meltdown. It has to be a principle that’s already in her repertoire, not something she thinks you’ve invented to trick her out of her misery.
Without minimizing true disorders requiring professional treatment, it’s important to step back and ask whether your child’s behavior might originate in something other than a psychiatric condition. We’ve examined a few possibilities, from Dabrowski’s overexcitabilities to traits of temperament. It’s only fair, after all, to consider non-pathological explanation along with pathological ones! This can bring new hope because the odds are that your child’s difficulty comes from the intersection of internal (temperament and giftedness) and external factors (components of the environment), rather than from a neurobiological disease.
Barbara Probst, MSW, LCSW, is a clinical social worker specializing in helping families whose “different” children have somehow become “difficult” children – often because their sensitivity, intensity, or giftedness is mistaken for a “disorder.” In addition to running parent support groups and working with individuals and families, she also teaches at Fordham University’s Graduate School of Social Service, gives presentations throughout the country, and is the mother of two adolescents. She is currently completing a book slated for publication in early 2008.