Are Gifted Children Frequently Misdiagnosed?

  • Are gifted children being misdiagnosed as having mental disorders like ADHD when they do not?
  • What is the likelihood of a gifted child having a mental disorder like ADHD?
  • Are gifted children more prone to having mental disorders and eating disorders than the average population?
 
To answer the question about whether gifted children are being misdiagnosed, it is important to examine the actual research data available about gifted children and mental health disorders. For almost 100 years, since Terman’s (1925) famous study of 1000 gifted children followed throughout their lifetimes, researchers have found gifted children, in general, to be above average in social and emotional adjustment, as well as advanced in academic areas, such as reading and math. Gifted children studied by Gottfried, Gottfried, Bathurst & Guerin (1994), in the Fullerton Longitudinal Study, were found to show early intrinsic motivation, superiority in attention, persistence, curiosity, enjoyment of learning and desire for mastery and challenge. This holds true for the vast majority of gifted children.
 
As IQ increases, however, there is some evidence that social and emotional adjustment is more difficult, and a lower percentage of these children (above IQ 160) appear to be well adjusted. Hollingworth (1942), described an optimal level of intelligence, between 120-145, where gifted children were not so different from age peers that they did not fit in. These are generally the children, in fact, chosen as leaders by their more average age peers. In the higher IQ ranges (160+), gifted children experience enough difference from age peers that they do not fit in with age peers. These children can show less optimal social and emotional adjustment (Hollingworth, 1942). Janos (1983, cited in Janos & Robinson 1985) found that the percentage of exceptionally gifted children (IQ 160+) having psychosocial difficulties was 21%.
 

Are gifted children frequently misdiagnosed with AD/HD?

 
There are no research studies in the literature that have examined how frequent misdiagnosis is, or if it actually occurs at all. ADHD is the misdiagnosis most often mentioned in published writings in the field of gifted children; yet, no one has done a research study that showed that gifted children are commonly misdiagnosed with ADHD. A critical examination of the literature indicated that gifted children without ADHD do not show the deficits in attention, inhibition, distractibility, performance speed or executive functions that are shown by children with ADHD, and these are not traits of giftedness.
 
A number of authors suggest, but have no research data to support their contentions, that gifted children are being misdiagnosed, particularly with ADHD. Studies of gifted children with ADHD compared to gifted children without ADHD have shown that gifted children with ADHD score lower than gifted peers without ADHD on Full Scale IQ scores, Working Memory and Processing Speed on the Wechsler Intelligence Scale for Children , as well as on tasks of inhibition. Gifted children with ADHD scored lower on tasks that measure attention speed, and ability to inhibit responding (Radisavljevic, 2011).
 
There have been few specific studies of the prevalence of mental disorders in gifted children. The prevalence of ADHD in the general population is currently about 9% (Akinbami, Liu, Pastor & Reuben, 2011). No one knows the prevalence of ADHD in the gifted population because no one has done such a study. There is little reason to think that traits of ADHD are common in gifted children without ADHD, or that ADHD is being misdiagnosed in gifted children.
 
Like other children with ADHD, gifted children with ADHD can focus on material of interest, material that is highly stimulating, novel material, and material that is personally relevant (Brown, Reichel & Quinlan 2011; Lovecky, 2004). Their school performance is erratic as tasks fluctuate in these elements. At home they can hyperfocus on tasks of their own choosing for hours (Kalbfleisch 2000, cited in Kaufmann, Kalbfleisch & Castellano, 2000). Thus, it is necessary to evaluate the child on tasks that other gifted children can perform but are moderately boring.
 
 

Are gifted children at higher risk for eating disorders?

 
When people with anorexia nervosa from all socio-economic groups are studied, the mean IQ is slightly higher than average. What might be concluded from these studies is that people with anorexia or other eating disorders are likely to have average or higher IQs. It does not mean that gifted children are at higher risk for eating disorders.
 
To state that gifted children have a greater than average risk, one would need to know the prevalence of eating disorders in the gifted population. Gifted adolescents were compared to average students on body dissatisfaction (a problem common to people with eating disorders), gender, type of student (gifted or typical), overall overexcitability, and social coping. In this study, the factors of overexcitability, gender and social coping ability were related to body dissatisfaction, but giftedness was not. There was not a higher percentage of gifted students among the group with the most body dissatisfaction (Stevens, 2013). There may be an added risk of developing anorexia nervosa for gifted dancers, or perhaps dancers in general, but there is no proof that it is likely to be a general risk factor for gifted children.
 

Are gifted children more at risk for obsessive-compulsive disorder (OCD) or depression?

 
Searches of the literature about OCD and high IQ or giftedness produced few studies. Grisham et al. (2011) found that for adults with OCD, one of the risk factors in childhood was a lower than average IQ. There is no clear correlation between IQ and OCD and no clinical evidence that gifted children are at higher risk for the disorder.
 
For depression, research has indicated that younger gifted children showed less anxiety and depression than average children, and for adolescents, there was no difference between gifted and average groups (Davis, 1996). Martin, Burns & Schonlau (2010), in their meta-analysis of studies of giftedness and mental health disorders, found no higher levels of depression, anxiety or suicidal ideation among gifted children when compared to average children.
 
Far from there being strong clinical support for the contention that gifted children are at increased risk for some mental disorders, there is only some support for an association between bipolar disorder and very high (or very low) IQ. This is not the same as saying that gifted children are, as a group, at increased risk.
 

What parents and clinicians need to know

 
Gifted children deserve a good analysis of why they are having problems in school and/or at home. Clinicians should recognize that for gifted children, the greater danger is not that they will be misdiagnosed, but that those with ADHD and other mental health disorders will not be diagnosed at all in the mistaken belief that all their negative behaviors can be attributed to their giftedness and boredom in school. By the time the symptoms become so overwhelming that the child is failing, it can be difficult to get the accommodations and remediations needed.