Giftedness and Dual Diagnosis
Updated: Aug 26
The Australian Association for the Education of the Gifted and Talented (AAEGT) estimates that there are at least 300,000 gifted students in schools across Australia. Catering to these students has long been a challenge for educators, policymakers, paediatricians, psychiatrists and psychologists.
The worry is that we are leaving our brightest children behind is one that’s ever-present.
One of the ways we traditionally fail gifted children — and eventually gifted adults — is through the identification and misidentification of mental health issues.
Giftedness is not to be confused with a mental disorder. It represents individual difference that should be celebrated, even when it’s challenging.
Yet, highly gifted children present real challenges to paediatricians, psychologists, and psychiatrists. The issues they present can come with diagnostic errors that occur on both sides — either a misdiagnosis of a mental illness where there is none or losing sight of true indicators of a diagnosis because the child’s giftedness hides it.
Gifted children who struggle with their mental health both need and deserve to be correctly diagnosed and treated. To achieve this, advocates say that both issues should be taken together as a dual diagnosis.
What is a Dual Diagnosis for Gifted Children?
Being gifted is an individual difference. It’s not a problem. So what do we mean when we talk about a dual diagnosis for gifted kids?
As Web et al., write, “In some situations where gifted children have received a correct diagnosis, giftedness is still a factor that must be considered in treatment, and should really generate a dual diagnosis.”
This dual diagnosis doesn’t suggest that their giftedness is a hindrance or disability. Instead, it’s another way of expressing human difference. More importantly, it reminds those of us who care for gifted children that we need to take an approach that always considers gifted children’s internal and situational factors.
What does this mean? As research regularly shows, there are personality factors correlated with high intellect and outstanding creativity. For example, as Silverman (1993) and Webb (1993) point out, gifted children and adults tend to express intensity and sensitivity that manifests itself in their personalities and thus in their everyday life.
Gifted children take their talents, interests, and passions to the next level. As a result, you will also see their social reactions continue accordingly.
How Gifted & Talented Kids Get Misdiagnosed
Normal giftedness is often confused with DSM mental disorders. It’s not unusual for gifted kids to be perfectionists, be introverted, struggle socially, or have interests that consume their days and nights as well as personalities. When you add in intensity and sensitivity, these behaviours and experiences are difficult for any adult to miss.
One of the problems gifted children face is that they have behaviours society celebrates— but often only on paper.
Within the confines of the traditional classroom or the workplace, power structures and hierarchies define ways of living. Bucking the status quo and demonstrating the kind of intensity and sensitivity often found in gifted children isn’t seen as an advantage. It’s a threat or a disturbance.
Even today, too few people have the training and experience to identify these behaviours and see them for what they are.
The same lack of experience and unacceptance of difference can also lead to misdiagnoses by paediatricians and even mental health professions.
The most common misdiagnoses include:
Attention Deficit Hyperactivity Disorder (ADHD)
Oppositional Defiant Disorder (ODD)
Obsessive Compulsive Disorder (OCD)
If you're a parent of a gifted student, then you may recognise this list of misdiagnoses.
It’s not uncommon for other adults in your life to “suggest” to you that your child may have one of the above conditions based on your child’s behaviours. They may have no reason or training to do so, and these informal diagnoses have no merit. But they happen every day as adults try to make sense of gifted children’s experience without considering the internal and situational factors that make gifted kids and their experiences unique.
At the same time, giftedness is a coexisting factor in some accurate diagnoses. The key is to pick apart the nuances between a DSM disorder and individual differences.
How Giftedness Masks Some Mental Health Conditions
There’s no doubt that giftedness can mask some mental health conditions. With a commitment to identifying the subtleties in the relationship between mental health conditions, social difficulties, and extreme giftedness, children and adults can be easily misdiagnosed and then enter treatment plans that don’t see beyond a surface-level interpretation of a child’s behaviours.
While an earlier school of thought argued against misdiagnosis in terms of slapping a DSM label on a child who is gifted and faces difficulties, current research suggests that the greater risk to profoundly gifted children is that of missing a diagnosis altogether.
As a result, it’s important for parents and caregivers to advocate for their child to receive a comprehensive assessment.
Studies show that parents tend to have a better idea of their child’s giftedness than other adults in their life. Trust that you also have a better understanding of their struggles, and don’t be afraid to push when you feel your child needs extra help.
Giftedness is a Factor in Diagnoses and Interventions
Giftedness, along with all differences, is to be celebrated, appreciated, and nurtured. Unfortunately, a lack of experience, understanding, and funding tends to leave gifted children in the lurch both in schools and in clinician’s offices.
Even today, some gifted kids are diagnosed, labelled, and medicated for disorders they don’t have, and others continue to struggle because they don’t have the diagnosis they need. The problem doesn’t even consider the many children who are gifted but who are never identified as gifted and are left to languish in classrooms and programs that don’t suit them.
Kids who are both gifted and have other health conditions need their giftedness considered in both their diagnosis and intervention. Hence, it’s essential to seek help and advice from professionals who understand the need to consider the dual diagnosis and recognise that there are subtleties.