Where Does a Pediatric Doctor Fit in the Care of Gifted Children?

By Marianne Kuzujanakis, MD, MPH.

Citation: First published in the SENGVine, October 2011.

I wear two hats: One—as a pediatrician. The other—as a parent of a gifted child. To be honest, there are days when neither hat fits comfortably, if at all. There are days when my medical knowledge just isn’t enough to understand my child, and other days when being a parent hasn’t always provided all the answers.

Can there be a synergy of these two roles?

Gifted kids do not suddenly become gifted on the first day of Kindergarten, nor are they gifted only during school hours. Most, if not all, parents may admit they felt hunches about their child’s abilities well before school age. Some parents may have even had concerns or questions about their child’s giftedness during these early years, yet they didn’t always know to whom to turn. Raising a gifted child can at times be a lonely and demanding journey for parents, and growing up as a gifted child is frequently fraught with challenges. Reaching out for an understanding voice may be difficult. Thus, many parents seek out organizations like SENG, as well as close friends and family members who can offer advice and support.

A sometimes overlooked individual who is ideally positioned to offer parents advice and support is the child’s medical doctor. These doctors may be pediatricians, family practitioners, naturopaths, or other allied health professionals. Many happy parents already find great comfort and advice from their children’s doctors, though others, for a variety of reasons, do not. Some parents may never have broached the subject of giftedness with their child’s doctor, considering giftedness not a medical issue, or feeling that discussing giftedness is marked with elitism. Doctors may feel likewise, and avoid the topic altogether. Some parents may also recall uncomfortable conversations with their child’s doctor or a previous doctor when giftedness was bought up, then quickly dismissed, and that made them hesitate to ever again discuss the subject. Some doctors, upon hearing about a child’s giftedness, may simply respond with “That’s wonderful. You must be lucky to have such an easy child to raise.” Argh.

By the time a child is five years of age, a child has typically seen his or her pediatric doctor a dozen times for healthy visits. With an average physical exam lasting twenty minutes, this amounts to four hours of face-to-face contact in those first five years, then one visit per year thereafter. Each visit is an opportunity – or missed opportunity – to address social, emotional, and developmental issues.

But is it important that pediatric doctors understand and address giftedness?

Medical doctors diagnose and treat a wide variety of acute and chronic medical conditions. Most are highly trained to do their job. Lectures and study about giftedness are not routinely part of the curriculum in medical training programs, yet giftedness can often play a significant role in the health and emotional well being of a gifted child. Reports indicate that doctors usually perform developmental assessments only 50% of the time, and these assessments primarily look at children not meeting the minimum standard developmental milestones. Many parents may be equally unaware that there is no specific pediatric medical record code (ICD or DSM) for “gifted.” Most doctors are compensated by the codes they indicate in the medical record. Having no specific medical code, many doctors, already overworked and pressed for time, have little incentive to discuss giftedness further.

When a child’s gifted needs are not served, the result can be expressed in a physical or emotional symptom. Many gifted children may experience bodily complaints as a result of a mismatch in their educational situation, or due to an unfulfilled emotional or social need. Stomachaches and headaches are common school avoidance symptoms. Eating disorders can be a result of poor self-esteem. Depression and suicidal attempts may result from feeling different or isolated or even bullied. Sensory intensities and the asynchrony of gifted children may be exhibited in extreme ways, sometimes making diagnoses difficult for those without knowledge of giftedness, and resulting in incorrect labeling of the gifted child. In other cases, a medical condition or learning disorder may almost completely hide one’s giftedness, as is seen in many twice-exceptional gifted children.

When worrisome health issues present at a pediatric doctor office, and if the doctor has a strong background knowledge of giftedness, he or she will be better positioned to understand and differentiate the symptoms from signs of giftedness, thus resulting in fewer misdiagnoses and fewer inappropriate medical treatments. If a doctor remains unsure of a presenting diagnosis, strong background knowledge of giftedness will still make it far easier to appropriately make any needed referrals, thus finding quicker answers for the parents and child.

Pediatric doctors are drawn into their careers by the thrill of working with children. They are among the most beloved of medical practitioners, and they do not take the privilege of caring for the youngest among us for granted. Many doctors are also gifted, and may understand the developmental paths of their gifted patients. They can be lifesavers for many parents who are anxious and exhausted by the enormous responsibility of raising these intense and complex children.

At the same time, many parents do not feel a need to discuss giftedness with their child’s doctor. Some parents feel able to be their own strong supportive advocates for their gifted children, and may also be gifted. Their children may have many friends who are gifted, and the stages of growing up are less bumpy, and more balanced. The personal need to discuss giftedness with one’s pediatric doctor in these situations may diminish.

But can parents do something to help make their good interactions better, or to improve their unsatisfying interactions, or even to help other more needy gifted families?