by Nadia Webb and Antara Dietrich
A neuropsychologist is not the first professional a family consults. I still spend time correcting people when they ask if I am a “Nurse/Psychologist.” Neuropsychologists work with neurologically-based behavior concerns such as problems with inattention, memory, planning, judgment, emotional regulation, and the like. Disorders of cognition and emotion are intertwined with neurobiology. Sometimes problems are acquired through an illness or injury; sometimes they are the expression of a genetic vulnerability. The gifted are not immune, although they may present a more complicated picture.
Mind and brain are inseparable in sickness and in health. The nervous system responds and adapts to the demands we place on it. Every skill we learn and every memory we form lasts because of changes in the brain; it is stored as a chemical and electrical trace. A whole child approach to the twice-exceptional child should include a child’s social context (such as family, school, and friendships); it will also include mental health and neurobiological well being.
Neuropsychologists tend to see a wider range of issues, and the profession is less perplexed by the idea the great ability and inability can sit side-by-side. It is routine, and very few neuropsychologists doubt the idea of twice exceptionality. We see physicians, artists, judges, and professors who have suffered small strokes or brain injuries from low impact automobile accidents. We see brilliance and deficits in combination as our profession. A gifted child with an attention deficit, dyslexia or an auditory processing problem is another variant. Not only do we find it plausible that a child can be twice exceptional, we find it logical. This is not a common perspective; despite thirty-plus years of documentation that gifted children can be learning disabled or otherwise neurologically compromised (Baum and Owen, 1988; Fox, Brody, and Tobin, 1983; Whitmore, 1980). One of the greatest difficulties in working with twice-exceptional children is helping school personnel move beyond the “One Label per Customer” model. Because of this mode of thinking, children tend to be defined by their gifts or their deficits, but not both. Once one label has been applied to a child, the quest for answers ends. The child identified as gifted receives little support even when learning disabilities are identified. The child identified as learning disabled is given remedial services, but rarely challenged or offered acceleration. In fact, teachers’ usually lower standards for children identified as learning disabled, even when they are intellectually advanced (Richey & Ysseldyke, 1983).
Often the twice-exceptional child is identified as neither because an inferior mediocre performance in a bright child can seem “average.” They tend to drift through classes underachieving, but blending in. Their difficulties remain unaddressed and their potential undeveloped. They receive nothing. However, because they get by, the resources go elsewhere. The cumulative effect is slower academic gains and falling further behind in expressing their potential.
Being gifted may allow you to compensate more gracefully, but it doesn’t buffer us from the neurological vagaries of life. We tend to frame the question of the twice-exceptional backwards, which contributes to our collective myopia. Instead of asking why gifted children should have learning disabilities, we should be asking, “Why shouldn’t they?” Giftedness provides no immunity against genetic vulnerabilities or injuries. We are all susceptible to tiny chromosomal variants and genetic repeats. Intellectual ability doesn’t protect from cancer, diabetes or toxin exposure, nor does it cushion impact in a car accident. Gifted children are not immune from any disorder. Michael Pyryt (2005), suggests it would be reasonable to consider that gifted children would have at least the same incidence of these disorders as would children in general, unless we find good evidence to the contrary.
Anyone who has seen a brilliant colleague recover from a small stroke or concussion has seen deficits and brilliance co-exist. Newton suffered from mercury poisoning in 1677 and in 1692 as a consequence of his scientific experimentation. Colleagues and friends noted progressive cognitive decline and psychotic thinking after each episode – with only partial recovery (Klawans, 1990). Only Newton’s research on optics predated his first exposure. Although impaired, he went on to reckon the movement of the planets, provide a foundation for physics and the understanding of gravity, and independently derive calculus. Newton himself observed that he lacked his “former consistency of mind.”
We are only marginally comfortable with the idea that the psyche dwells within an internal organ. What we see is shaped by what we know, and we are blindest to the disabilities that do not fit our preconceptions. Most of us have a narrow perspective on the range of neurological “faults” in the wiring. For example, few of us know that learning disabilities and psychiatric disorders can be acquired. Learning about the twice-exceptional is often the unlearning of suppositions. A gifted mind is housed in a delicate structure that has the consistency of Jell-O. The long cables connecting one neuron to another have the texture of wet spaghetti. A car accident at seven miles per hour can send this soft mass careening around in the skull. The soft spaghetti-like strands are pulled, twisted, and compressed – shearing and damaging many of them in the process. The gelatinous brain slides and pivots across the knifelike ridges that line basin of the skull, often bruising against the hard surface of the skull as it ricochets.
As a neuropsychologist, I know that I am one blow away from being a janitor with three advanced degrees. We can protect our child’s gifts by requiring sports helmets and teaching that seat belts are not optional. We can also acknowledge that high fevers, anoxia from asthma, mild head injuries, seizures, and the like may have surprisingly significant consequences. The brain can have precisely located skills as well as more complex systems. Recently, researchers found neurons in the visual area of the cortex that fire only to pictures of Jennifer Anniston (Quiroga, Reddy, Kreiman, Koch, & Fried, 2005). While the loss of a Jennifer Anniston neuron might not be a complete tragedy, the idea that some of our skills hang by such a fragile tether is justifiably unnerving.
It does not make it easier to identify learning disabilities and similar neurologically-based issues when they arrive in a variety of strange permutations. When someone says they have dyslexia, the correct response should be “which one?” There are nine identified subtypes of dyslexia, as well as five identified kinds of attention problems, each of which responds best to a different intervention. These subtypes have been identified in a normal population, on and for whom the tests were developed. Gifted children can be even more challenging to identify because their coping strategies can help or hinder identification.
We are blind to the disabilities we are unfamiliar with or those we think that we understand. Preconceptions shape what we observe. For example, we have no difficulty imagining a brilliant child with a speech impediment but we struggle to imagine a brilliant child with a reading impediment. Listening involves hearing and blending sounds into words; speaking involves making and blended sounds into words. Reading is correctly perceiving and sequencing visual marks that stand in for sounds that can be blended into words. Reading is the more complicated t