Since 1998, the percentage of children diagnosed with ADHD has been increasing. In 1998, about 7% of children were diagnosed with ADHD. By 2009, the percentage had increased to about 9% and by 2011, it had risen to nearly 12%. Those percentages suggest that 5.3 million American children have ADHD. But there is more to the story than that, particularly where gifted children are concerned.
For one thing, those figures represent averages of all children between the ages of 5 to 17. The percentages for boys diagnosed with ADHD are nearly double those for girls. In 2009, for example, about 12% of boys, but only 5.5% of girls were diagnosed with ADHD. However, the percentages of girls diagnosed with ADHD has been increasing. The diagnosis of ADHD for both both boys and girls increased 43% from 2003 to 2011, but for girls alone, it increased 55%.
What about gifted children? None of the research on diagnosis of ADHD over the years includes data for the gifted population. However, we do know that the signs of a bored gifted child in the classroom are similar to those of a child with ADHD. Compare these lists of characteristics:
Characteristics of Gifted Students Who Are Bored
- Poor attention and daydreaming when bored
- Low tolerance for persistence on tasks that seem irrelevant
- Begin many projects, see few to completion
- Development of judgment lags behind intellectual growth
- Intensity may lead to power struggles with authorities
- High activity level; may need less sleep
- Difficulty restraining desire to talk; may be disruptive
- Question rules, customs, and traditions
- Lose work, forget homework, are disorganized
- May appear careless
- Highly sensitive to criticism
- Do not exhibit problem behaviors in all situations
- More consistent levels of performance at a fairly consistent pace
Summary of ADHD Characteristics from the DSM-V
(6 or more in children, 4 or more in adults)
(6 or more in children, 4 or more in adults)
|* Fails to give close attention to details
* Difficulty sustaining attention
* Does not seem to listen
* Does not follow through
* Difficulty organizing tasks
* Reluctant to engage in tasks that require sustained mental effort
* Loses objects
* Easily distracted
* Runs about
* Excessively loud
* “on the go”
* Talks excessively* Blurts out an answer
* Difficulty waiting his or her turn
* Interrupts or intrudes
* Acts without thinking
* Uncomfortable doing things slowly and systematically
* Difficult to resist temptation
Can you see some similarities? It’s no wonder that a gifted child who is not sufficiently challenged in school may look like a child with ADHD to those with little or no training in recognizing giftedness.
Problems with Diagnosis of ADHD
Comparing those lists of behaviors should make it clear why gifted children are often diagnosed with ADHD, but there are other problems with the ADHD diagnosis. One problem is that few valid diagnostic tools are available for children under the age of 6, and yet one third of those children diagnosed with ADHD were diagnosed before they were 6 years old. Another problem is that one fifth of the children diagnosed with ADHD were diagnosed with information obtained from family members alone, but the AAP (American Academy of Pediatrics) recommends that information be gathered from a variety of people in a variety of settings. It is not enough to give a parent a checklist – which looks very much like the lists of characteristics from the DSM.
Another problem with the diagnosis of ADHD is that the first person to call attention to a child’s behavior, attention, or performance is often someone at the child’s school or daycare. In other words, it is a teacher who brings up ADHD behaviors with a parent. According to a National Health Report, one third of those children diagnosed with ADHD were first suspected of having ADHD by someone at the child’s school.
Once a teacher brings up the problem behaviors, he or she will suggest that the parent get the child assessed for ADHD. The parent may then take the child to a pediatrician, who typically gives the parent a checklist to fill out and from that a diagnosis of ADHD is made. Not all pediatricians are qualified to assess ADHD. Most teachers aren’t qualified either. And too few teachers understand giftedness, so it is more likely that a teacher will interpret problem behaviors as the result of ADHD rather than stemming from giftedness.
Importance of the Correct Diagnosis
Many people are beginning to question the validity of the ADHD diagnosis because of the drastic increase in the number of children being diagnosed with the disorder. Of course, many of us have long questioned the diagnosis of so many gifted children with ADHD. Far fewer people are familiar with giftedness than they are with ADHD, and many of those familiar with ADHD don’t fully understand how the disorder manifests itself. It’s no wonder, then, that traits common to gifted children might be seen as symptoms of ADHD.
Questions to Ask to Help Differentiate between Giftedness and ADHD
Colleen Willard Holt created a list of questions that should be asked in order to determine if a child has ADHD or may be be a bored gifted child.
- Could the behaviors be responses to inappropriate placement, insufficient challenge, or lack of intellectual peers?
- Is the child able to concentrate when interested in the activity?
- Have any curricular modifications been made in an attempt to change inappropriate behaviors?
- Has the child been interviewed? What are his/her feelings about the behaviors?
- Does the child feel out of control? Do the parents perceive the child as being out of control?
- Do the behaviors occur at certain times of the day, during certain activities, with certain teachers or in certain environments?
Gifted children often “act out” when the work they are asked to complete does not provide enough intellectual challenge. Their behavior can improve drastically literally overnight when they are given more challenging work. (This happened with my son.) That is not true of children with ADHD. It is not surprising, therefore, to learn that gifted children exhibit problem behaviors at school, but not at home or in situations where they are with their intellectual peers. Children with ADHD, on the other hand, will exhibit the problem behaviors in a variety of settings.
It is certainly possible for a gifted child to have ADHD, but it’s more difficult to diagnose than it is in non-gifted children. They may, for example, still exhibit problem behaviors even after being given more challenging work. To many, that is a sure sign that the child isn’t gifted, just ADHD. But gifted children with ADHD are among the 2e (twice exceptional) population. These children need accommodations in school that address both their giftedness and their ADHD. It is not enough to deal with just one. It is also not enough to treat a child as though he has ADHD when in reality he is simply gifted, particularly when that treatment may include a Schedule II drug like Ritalin. (Cocaine, morphine and amphetamines are also Schedule II drugs.) It’s extremely important that our children be properly diagnosed.
Akinbami, L.J. Liu, X., Pastor, P. N., & Cynthia A. Reuben, C. A.(2011). “Attention Deficit Hyperactivity Disorder Among Children Aged 5–17 Years in the United States, 1998–2009.” NCHS Data Brief No. 70.
CDC. (2016). New Data: Medication and Psychological Services Among Children Ages 2-5 Years (Healthcare Claims Data). Attention-Deficit / Hyperactivity Disorder (ADHD)
Chappell, E. (2013, March 19). “Twice exceptional (2e): Gifted with ADD/ADHD, Part 2.” Coppell Gifted Association. (https://coppellgifted.org/2013/03/19/twice-exceptional-2e-gifted-with-addadhd-part-2/)
Hartnett, D.N., Nelson, J.M., & Rinn, A.N. (2004). “Gifted or ADHD? The Possibilities of Misdiagnosis.“Roeper Review. 26:2, pp. 73-76.
Visser, S.N. Dr.P.H., M.S., Zablotsky, B. Ph.D., Holbrook, J.R., Danielson, M. L., & Rebecca H. Bitsko, R.H. (2015, Sept 3). National Health Statistics Report #81.
- A True ADHD Epidemic or an Epidemic of Overdiagnosis?
- The American Psychiatric Association’s DSM5 proposal for ADHD – Making lifelong patients of even more healthy people
- When diagnosing ADHD, consider possibility of giftedness in some children
- Interview with Marianne Kuzujanakis on Misdiagnosis