Gifted and active ?

Many gifted children are very active from the beginning. They are constantly asking questions, they want to touch and explore everything, they want to be doing something interesting all through the day. They never seem to stop and they don't want to sleep. For those observing, they seem to be constantly on the go and for parents it can be exhausting trying to keep up with their intensity of interest in a particular area or the world around them. It is not long before family or friends may suggest that there is a problem. When they start school their excitement to learn may lead them to blurt out answers rather than waiting their turn.  They may get distracted from the task a teacher has set when an interesting thought pops into their mind. They may miss the teacher's instructions as they are engrossed in the book they are reading. They may be constantly moving as they try to act on the ideas they have straight away. Again it is not long before the teacher suggests that your child has ADHD.

Gifted with ADHD or just gifted?  What difference does it make?

Quite a lot really, when we focus on the 'behaviours' rather than the reasons for the behaviours we can come to the wrong conclusions.  We always have to consider whole child before we make any judgements. The trouble with misdiagnosis is that the child receives the wrong 'treatment' and the real cause for their difficulties is not dealt with.

James Webb and his co-authors of 'Misdiagnosis and Dual Diagnoses of Gifted Children and Adults' estimate that as many of 50% of gifted students who are given a diagnosis of ADHD do not actually have ADHD but rather are displaying characteristics that are inherent to gifted students. While it is perfectly possible to be gifted and have ADHD the treatment for this is different to a gifted child who is having attention difficulties in a specific context.

There are many areas of overlap between a gifted child and a child with ADHD and so it easy for confusion to arise even with teachers, educational and medical professionals.  The Conners' rating scales lists 50 or so behaviours for teachers and parents to consider and rate on how often these behaviors are seen. Gifted children may display many of these behaviours but for a different reason than a child with AHDH. Considering the context of any behaviour is very important as is considering the child's strengths and weaknesses.

Inattentiveness can be caused by boredom and lack of challenge for many gifted students. This can then lead to daydreaming, disturbing class mates or finding creative ways to occupy themselves. It needs to be noted whether the problems occur at school or home or both. If at home a child can sustain their concentration to complete a task that they find interesting and mentally challenging then they probably do not have ADHD.  This does not include computer games or TV as these stimulate the brain in a different way.

Gifted children can appear not to be listening as they are deep in their own thoughts. They can also be distracted by sensory overexcitabilities. If you are absorbed by the annoying label in the back of your shirt or the buzzing of the lights it can be very hard to focus on what the teacher is saying. As an adult we can learn to filter out these annoyances but this often not possible for children.

Many gifted children are naturally active, have high energy and need less sleep. Psychomotor overexcitabilities can easily be mistaken for ADHD. As the child's mind is bombarded with thoughts so the body moves too. Sometimes a gifted child is so excited by what they are thinking or have discovered that they speak quickly, move excitedly and want to act on the idea straight away.

The things to look out for in a child who has ADHD are lack of attention to detail, difficulty sustaining focus even in play activities, failing to finish tasks, difficulty sustaining mental effort, being disorganised and being easily distracted by extraneous stimuli.

When seeking professional advice it is important that IQ testing is included and that environmental factors are considered.  For ADHD to be diagnosed it should occur in two or more contexts. It is also important to consider the child's developmental history or early childhood.  If the problems only occurred when the child started school or as the curriculum became more demanding then the difficulty is probably not ADHD.  Signs of ADHD should be evident before the age of 7 for a diagnosis to be made.

For those who are simply gifted we need to take a serious look at what is causing problems at school or in another context. A better understanding of gifted children by may be needed for those involved with the child.

Once we have the diagnosis right, how do we help a gifted child with ADHD?

Medication is one of the first things mentioned when we think of ADHD.  While it clearly does help many children it does not need to be our first or only strategy.

Occupational Therapy can be hugely helpful for many active children and those who find it hard to focus.  Occupational therapists are able to identify if there are sensory factors or other factors causing the movement and they can help children learn to regulate themselves.  Children can be over stimulated and they need strategies to calm down to focus on academic tasks or they may be under stimulated and need strategies to wake the brain up. Movement breaks with a specific programme of activities are key in helping a child to remain focused. Simply having a toilet break or a drink is often not enough, sometimes children need a much more active break with star jumps, running, press ups, bouncing on a yoga ball.

Adapting the environment and the expectations of the child is also important. This can be easier to do at home than at school which is why parents often do not see the problems in the way schools do. We may naturally incorporate active tasks and breaks into our day as we know what works best for our child.

In school, tasks do not need to be less challenging but rather they should be broken down into 10 minute blocks with breaks in between.  Some children need to be allowed to fiddle or move as it actually helps them focus. Trying to prevent movement is usually counterproductive. It is more a case of finding things that work in a school context and are not disruptive or distracting for others. Again there are many things that can be trialed: velcro under the desk, bendy rulers, theraband around the chair, blue tac, wobble cushions, standing desks. However we have to be careful that these things do not become a distraction in themselves.

ADHD can also affect the way the brain processes, plans and organises tasks. Very often children know 'what' to do and 'how' to do it but their brain does not tell them 'when' and 'where' to use the skills and knowledge they have.  For example the child many know that they have a homework project which requires time for research and making a presentation but they may not think about when to start it or which part to do first. So they may leave it all the the night before the project is due. Check lists and visual prompts can be helpful in helping a child to organise themselves to work through a task in sequence and to know which skills to draw upon. These will need practise and adult prompting initially before a child can use them independently. The child may also have a poor sense of time, so the use of timers can be useful in helping a child know how much time has passed or encouraging the child to stay focused for increasing amounts of time before taking a break.

This article is only a brief overview of some of the issues connected with giftedness and ADHD, for more reading and information have a look at www.additudemag.com and www.understood.org