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Before Referring a Gifted Child for ADD/ADHD Evaluation

By Sharon Lind.

Parents and gifted educators are asked with increased frequency to instruct gifted children to conform to a set of societal standards of acceptable behavior and achievement — to smooth the edges of the square peg in order to fit into a “normal” hole. Spontaneity, inquisitiveness, imagination, boundless enthusiasm, and emotionality are being discouraged to create calmer, quieter, more controlled environments in school. An extension of this trend is reflected in an increase in referrals for medical evaluation of gifted children as ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder). There is no doubt that gifted children can be ADD/ADHD. However, there are also gifted children whose “inappropriate behavior” may be a result of being highly gifted and/or intense.

This intensity coupled with classroom environments and curriculum which do not meet needs of gifted, divergent, creative, or random learners, may lead to the mislabeling of many children as ADHD. To avoid mislabeling gifted children, parents and educators may want to complete the following check list to help them decide to refer for medical or psychological evaluation.

If, after addressing these questions, parents and teachers believe that it is not an unsuitable, inflexible, or unreceptive educational environment which is causing the child to “misbehave” or “tune out,” or if the child feels out of control, then it is most certainly appropriate to refer a gifted child for ADD/ADHD diagnosis. Premature referral bypasses the educational system and takes control away from students, parents and educators. By referring before trying to adjust the educational environment and curriculum, educators appear to be denouncing the positive attributes of giftedness and/or to be blaming the victim of an inappropriate educational system.

When deciding to refer, parents should search for a competent diagnostician who has experience with both giftedness and attention deficit disorders. It is never appropriate for teachers, parents or pediatricians to label a child as ADD or ADHD without comprehensive clinical evaluation that can distinguish ADD/ADHD from look-alike with other causes.

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I am puzzled by the assumption that it has to be either or, as well as largely ignoring masking behaviours and features of ADHD that include very much differences in behaviour when a subject matter is of interest. Increasing the threshold for access to diagnosis of twice exceptional individuals is harmful and I'd much rather see a focus on a comprehensive assessment process which includes assessment for giftedness, masking and other co-occuring neurodivergencies or comorbidities than making it harder for 2e people who are already very easily overlooked and underdiagnosed due to academic success and masking.

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