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Why Are Assessments and Screening Tools Missing Co-occurring Diagnoses of Gifted Kids?

By Julia Rutkovsky, LCSW; Melissa Sornik, LCSW; Jacob Greebel, LMSW.

As any parent of a gifted kid could tell you, giftedness comes with lots of testing. Add in the fact that gifted kids often have co-occurring needs in the areas of mental health, learning, or executive functioning, they may need even more testing. Why is it then, that when a gifted kid, who is clearly smart yet struggling, is screened, they often come up average and don’t qualify for services?

Many of the most commonly used screening tools have not been updated as recently as the newest edition of the DSM, so as we learn more about mental health diagnoses, we are not using our evolving knowledge to improve assessment measures. Our current screening tools miss gifted children’s particular needs for several reasons. The first, and perhaps most common, is that gifted kids are excellent maskers. Masking is the concealment of certain behaviors to better blend in. Not only do gifted kids mask, but some are even gifted in the art

of hiding their challenges. In one example, the diagnosis of an incredibly gifted autistic child was questioned because he made excellent eye contact. While discussing this in session, the child revealed that he knew eye contact was expected, so he purposely looked at the area right next to the eye when he was talking to others. Gifted kids understand that when they’re being tested, evaluators are looking for something “wrong.” For kids who have spent their lives being the smartest person in the room, being wrong can feel tragic. Over time, they develop tools to avoid identification, not because they don’t want help, but because the idea of being inferior is identity shattering. Gifted students feel compelled to “do well” as they always have, even on screeners meant to measure where they could be better supported.

Gifted kids begin masking before they even have the words to identify it. When screening tools assess childhood behaviors and rely on parent reports, the masking further prevents accurate screening. In the case of an adolescent pursuing the diagnoses of ASD and ADHD, a parent reported that the child never had issues in school. When the diagnosis was not given, the child was confused, since the truth was that they were never able to pay attention in class. What really happened was that the child could not pay attention but was gifted enough that their work was always correct, and the teachers never bothered to let the parent know because the attentional issues weren’t impacting their schoolwork. The child masked their attentional issues by being quiet when unfocused and producing excellent work; and by assessing their childhood behaviors, the masking continued to prevent the child from getting services they needed. Many gifted children are able to mask in elementary school and even middle school; but as demands increase, they begin to falter. When they seek services in adolescence, they may struggle because some diagnoses require evidence of childhood presentation. It’s not that the presentation wasn’t there in childhood — it’s that the child masked and as the demand increased, the masking became harder.

When pursuing a lengthier evaluation such as an educational or neuropsychological assessment, an evaluator will usually observe a child in their school or another setting. Observation can give key insights into the child’s presentation. If they are observed in an environment where they are likely masking, such as school, it doesn’t always present an accurate picture. If a child with emotional regulation deficits goes to school and masks all day, only to come home and fall apart in a tantrum because they can’t hold it together anymore, a school observation is likely to indicate the problem is in the home, which is not accurate.

One particularly common faux pas that happens when evaluating a gifted child academically is that while all the scores are above average, the discrepancy between scores gets ignored. Any large discrepancy between scores can cause challenges, which are often expressed emotionally or behaviorally. If a child with extremely high intelligence scores just average in processing speed, there can be an immense amount of frustration and emotion when their knowledge can’t be applied as quickly as their brain is working. When a child with incredibly high verbal skills has just average expressive language skills, they may start to act out in anger when they cannot communicate their thoughts. These types of discrepancies occur in gifted children all the time, but if their lowest score falls into the average range, they may not qualify for the support they need in their discrepant areas. Until 2004, schools used a discrepancy model for evaluating students’ needs; it was replaced because educators and school officials thought it was unfair to focus on a child's area of relative weakness instead of their strengths. While a strengths-based perspective has many pros, the downside of replacing the discrepancy model is that we begin to miss gifted students with large discrepancies. In place of the discrepancy model, schools now use the Response to Intervention (RTI) model. While the RTI model itself doesn’t necessarily disadvantage gifted children, schools often will not intervene and provide support to a student whose lowest score is average, regardless of a discrepancy’s size.

So how can we begin to shift our screening and assessment tools to better catch the needs of gifted students? We need to stop looking at the test and start looking at the kid. Standardized screening tools are just that: a tool, and they are not always designed to identify non-standard kids. There is no perfect measure, and all evaluations should be looked at in the context of the whole child. For gifted kids, narrative assessment may need to play a larger role in identification. Looking at the discrepancy between scores, even if none of the scores are below average, can help explain some of the emotional and behavioral needs the child may be presenting. Observing a child in multiple settings, getting information from multiple sources, and assessing the child in front of you — not who they once were — will help ensure that we are serving gifted children as thoroughly as their neurotypical peers.


Julia Rutkovsky, LCSW is a clinical social worker and psychotherapist who specializes in working with Neurodivergent, Twice-Exceptional, and LGBTQ+ children, adolescents, and their families. Julia's private practice provides individual, group, and family therapy as well as school consultation and provider training in New York and New Jersey. Julia received her B.S. in Social Work and Theater from Skidmore College in 2016, and her Master of Social Work with honors from New York University's Silver School of Social Work in 2017. Julia has worked in several gifted and 2e settings including as Associate Director of The Quad Manhattan, School Social Worker at FlexSchool Bronxville, and as an individual and group psychotherapist at Melissa Sornik, LCSW PLLC. In addition to her LCSW, Julia holds advanced training in Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Exposure and Response Prevention (ERP), Meeting the Needs of Twice Exceptional Learners, Child and Family Therapy, Creative Arts Therapies, and Mindfulness. You can find more information about Julia's ongoing work at

The co-founder and president of Twice Exceptional Children’s Advocacy, Inc. (TECA) Melissa Sornik, LCSW has been working with gifted and twice-exceptional (2e) children and their families since 2003. Melissa earned her Master of Social Work degree from Fordham University with a specialization in children and families. With a private practice specializing in support and services for all kinds of gifted individuals, including those who are twice-exceptional, Melissa has developed programs for 2e children and adolescents, conducted professional development sessions for public and private schools and colleges in the NY tri-state area. She has authored several articles on the subject of 2e and has presented lectures and workshops at regional and national conferences. She maintains clinical practices both in New York City and in Sea Cliff, New York.

Jacob Greebel, MEd, LMSW holds a dual degree of Master of Education, for general and special education from Bank Street College, a Master of Social Work degree from Columbia University, and a Bachelor of Science degree in Psychology from the University of Wisconsin. Jacob has also taught in several alternative and progressive educational settings. Inspired by his own struggles as a 2e individual, Jacob strives to raise awareness and change perceptions of 2e children and adolescents by furthering his knowledge in both scope and depth as he continues to gain experience and share his discoveries with his students, peers, and parents alike.

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Jaden King
Jaden King
Dec 27, 2022

When pursuing a lengthier evaluation such as an educational or neuropsychological assessment, an evaluator will usually observe a child in their school or another setting.

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Dec 13, 2022

It is so true, it completely resonances.

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