A review of Misdiagnosis and Dual Diagnosis of Gifted Children and Adults: ADHD, Bipolar, OCD, Asperger’s, Depression and Other Disorders by James T. Webb, Edward R. Amend, Nadia E. Webb, Jean Goerss, Paul Beljan and F. Richard Olenchak. (2004) Great Potential Press, Scottsdale, Ariz. $29.95 hardcover, $19.95 paperback.
In 1966, Michael Wallach and Nathan Kogan identified a group of highly intelligent creative children. Observations in the classroom revealed that these children were a great challenge to teachers who frequently found it difficult to cope with their classroom behavior. These children comprise what is called “the gifted child.”
The challenge of the gifted child highlights a number of issues regarding how we diagnose and how we treat as well as how we educate our children. Often in our clinical practice we see a gifted child who is depressed, unmotivated, failing in school and functioning poorly in the family and community. All too frequently such a situation has resulted because the child has been ignored, misunderstood and/or labeled as stubborn, self-centered, unsociable, different or withdrawn. Ultimately that might lead to a diagnosis of a psychiatric disorder as described in DSM-TR. (I remember an urgent telephone call to a parent from a substitute teacher urging the child be punished because he asked the teacher, who had not been adequately prepared for the class, “I don’t know if you are here to teach us or to baby sit us.”)
This excellent book, authored by a five-member multi-disciplinary team of two clinical psychologists, a neuropsychologist, an educational psychologist and a pediatrician makes an impassioned plea for recognizing the unique social and emotional needs of the gifted child and adult. They urge great caution in diagnosing psychopathology in that group. They note that even the physiology in gifted children frequently differs from other children (they appear to have more allergies, sleep problems and discrepancies and uneven rates of development.) To emphasize their point of view they include a large number and wide range of descriptive case studies. Focusing on behavioral issues, they stress the difficulties in distinguishing pathology from psychomotor, emotional, intellectual, sensual and imaginational overexcitability.
The book had its start in the work of the group of practitioners in a program called SENG (Social and Emotional Needs of the Gifted) affiliated with the Wright State University Program in Professional Psychology. It is now a non-profit independent organization. (In an appendix, the book lists suggested readings and a list of organizations specializing on the gifted.)
The structure of the book is simple and it is extraordinarily well organized. Following the description of characteristics of gifted children and a list of frequent referral questions (such as “If he is so smart why does he have such poor judgment?” and “Why is he so argumentative?”) it goes on to describe the special needs of the group. Tables of the criteria for various disorders are reprinted from the DSM IV-TR Manual. With each disorder the similarities between the behavior of the gifted and those listed are discussed. Then carefully and thoughtfully the authors describe the features that are incompatible or contradictory with the diagnosis criteria. Indeed they add a category to DSM IV-TR, “existential depression,” that they say is common in the gifted as they feel that they do not fit in the family or the classroom.
The clarity of the writing is commendable. The authors recognize how the gifted can compensate for and effectively avoid and hide pathology, particularly with regard to possible learning disabilities and ADHD inattentiveness. They also do not reject medication if and when needed. Above all, the main message is that gifted children should be viewed in the context of the family, school and community with the realization that an environment that does not understand them or appreciate them (and often bores them) has a great effect on their behavior. In order to understand them, therefore, a comprehensive evaluation with information from many sources is necessary.
As they state, the consequences of a misdiagnosis or inadequate diagnosis is very profound particularly in the formative years. How one is seen by others and how one sees oneself has a great impact as decisions are made about possible intervention.
The value of this book should not be seen as limited to gifted children and adults. It brings into question what is happening currently in the whole area of the diagnosis of behavioral disorders. At the present time there seems to be a dumbing down of the diagnostic process. Psychological testing, for example, is being carried out mechanically separate from the context of other sources of information.
Assessments are made by minimally or poorly trained personnel using computerized results to determine what DSM category fits so reimbursement can be more readily obtained. Checklists, questionnaires and structured interviews are used with little effort to get a comprehensive picture of the history or some of the subtle environmental factors that affect the behavior. Because of time constraints, quick decisions are made and individuals labeled and treated without adequate understanding of the circumstances that lead to the behavior. This book is an excellent example of the kind of diagnostic thinking that represents the best ethical and professional functioning in our field. It is required reading.
Milton F. Shore, Ph.D., is a former member of the Board of Examiners of Psychologists for Maryland. He is in private practice in Silver Spring, Md.