In October of 2011, the American Academy of Pediatrics (AAP) released new clinical guidelines for the diagnosis of AD/HD. Published in the November issue of Pediatrics, these guidelines are causing concern among advocates for the gifted. The new AAP guidelines expand the age range for an AD/HD diagnosis from 6-12 to 4-18 and suggest that pediatricians evaluate any child who has a history of behavioral or academic difficulty for AD/HD.
While the guidelines also state that, "the primary care clinician should also rule out any alternative cause," Supporting Emotional Needs of the Gifted (SENG) has expressed concern that lack of knowledge of normal gifted behaviors among pediatricians may increase the risk of misdiagnosis. SENG is increasing its public awareness efforts about misdiagnoses of gifted children through a January 23, 2012 news release and a free YouTube video on the topic.
One of the hallmarks of AD/HD is inconsistency. A child with AD/HD, gifted or not, tends to show highly erratic performance on task completion and tests. For a gifted child, that may lead to achievement scores that vary between average and very high. The difficulty in distinguishing between a twice exceptional child with AD/HD and a bored gifted child is that bored children may also show inconsistent performance.
Dr. James T. Webb, co-author of Misdiagnosis and Dual Diagnoses of Gifted Children and Adults and founding member of SENG, does believe that AD/HD occurs in gifted children. However, he expresses concern that the risk of misdiagnosis increases as we attempt to identify younger gifted children with AD/HD.
Dr. Webb's misdiagnosis book suggests that a key difference between a bored gifted child and a gifted child with AD/HD is choice. A bored child may choose not to perform because the work in uninteresting. He may not have the maturity to make a better choice, but ultimately the thing that is preventing him from completing a task or doing it well is controllable by the child. A gifted child should never be asked to make the choice to suffer boredom gladly, none the less.
A gifted child with AD/HD may perform well in a highly structured environment but, left to work independently or in a setting with distractions, he often cannot perform on par with his abilities even if he is trying very hard.
When considering an AD/HD diagnosis in a gifted child, Misdiagnosis and Dual Diagnoses of Gifted Children and Adults suggests that a parent or clinician consider the following as indications that the issue is not related to AD/HD:
- inattentiveness, impulsivity, and other symptoms present for the first time when the child begins formal schooling
- the child can attend well to tasks that are challenging or interesting, but not when tasks are uninteresting
- the child shows prolonged intense focus when working in an area of passion or on a challenging task
- the child only interrupts others to correct their mistakes or blurt out correct answers
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