The complexity of ADHD diagnosis in young gifted children

by Lisa Rivero and Marianne Kuzujanakis, M.D., M.P.H.

According to her second-grade teacher, Emily (not her real name) didn’t pay attention. She zoned out. She talked about topics that her classmates found annoying, and she refused to write. “I think she has ADD or ADHD,” the teacher told her parents at parent-teacher conferences.

But the Emily they knew at home focused for hours on her many interests, especially science, and helped her older sister with math homework. The teacher continued, “I want the best for Emily, for her to make friends, to learn, and to be focused.” She urged the parents to seek a diagnosis and prescription from their pediatrician.

As a parent, what would you do?

As parents enroll their children in four-year-old kindergarten for the 2012-2013 school year, they should be aware that the American Academy of Pediatrics now recommends that primary health care providers start Attention Deficit Hyperactivity Disorder (ADHD) evaluation for children as young as four who present academic difficulties or traits associated with the learning disorder. The previous recommended ages for evaluation were six through 12. Four-year-old kindergarten is an increasingly popular program as the number of Wisconsin districts offering 4-K has doubled in the past ten years. According to the most recent National Center for Education Statistics, over six percent of Wisconsin students are identified as gifted. Screening for gifted programs, however, rarely begins in 4-K.

The problem for children like Emily and their families is that checklists for ADHD and intellectual giftedness overlap. Young, very bright children ask unusual questions for their age, pay unusual attention to details (but not always what someone else wants them to pay attention to), and often have interests that are beyond the interests of their peers, causing them to have difficulties fitting into age-based groups. Educators and even many primary health care providers are not equipped to know when these traits are signs of unusual intellectual ability that requires nurturing, learning differences that require accommodation, or both.

We want to be clear that ADHD is a real condition that affects both children and adults, for whom thorough and proper evaluation, diagnosis, and treatment are crucial if they are to get the most out of life and learning.  And ADHD can also coexist with giftedness, requiring an even greater understanding of both learning needs.

However, we urge all adults – parents, educators, and health care providers – to educate themselves about what giftedness looks like in young children and the unique developmental path of young people with high intellectual ability. To address this problem, the international non-profit organization Supporting Emotional Needs of the Gifted (SENG) is launching a global public awareness effort on the complexities of ADHD diagnosis in young gifted children. Find out more at, or attend the SENG national conference, July 13-14, 2012 in Brookfield.

What happened to Emily? Rather than immediately requesting a prescription from their family doctor, her parents sought out a thorough psychological evaluation, which uncovered exceptional intelligence and an understanding of science concepts several years above her grade level. When Emily was moved to a classroom for highly gifted children, she began to thrive, and eventually she entered college early, majored in science, and won a national award for one of her research papers.

We must do everything we can to prevent children like Emily from being misdiagnosed with a learning disorder they do not have or receiving medication they do not need.

Lisa Rivero and Marianne Kuzujanakis are Directors of SENG (Supporting Emotional Needs of the Gifted). Ms. Rivero lives in Glendale and teaches at the Milwaukee School of Engineering. She is the author of four books about education and parenting and is a blogger for Psychology Today. Dr. Kuzujanakis, who lives in Massachusetts, is a pediatrician with a master of public health degree from Harvard School of Public Health.

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  1. Gwyn says:

    It’s fascinating to see the story of my own child retold here in the form of Emily. At 6, my son’s 1st grade teacher was sure he had ADHD, but her unprofessional diagnosis had more to do with her own frustration and lack of understanding of his particular needs. His focus in other areas was and is profound, and he produces an incredible amount of creative work due to his active, often distracted mind. I shudder to think of his trajectory had we listened to that teacher and medicated unnecessarily. Thank you for this discussion.

  2. Julie Tyler says:

    Our family went through this same scenario. You have to you child’s advocate. he is now in 3rd grade and still advocating and we will never stop. The public school is on the whole pretty frustrating>J

  3. Gee says:

    Thank you for posting this for other parents — and their children. My daughter had decades of frustration due to teachers who misdiagnosed (yes, teachers put it on the record, as I did not know at the time, and without any doctors saying so) ADHD.

    Some of her symptoms/behaviors were the same, but had the teachers told us what they saw, we might have been able to get my daughter the diagnosis from a doctor a lot sooner — and before her seizures worsened to full-body seizures. Yes, seizures, which had been “only” the lower-level, clonic-tonic, “petit mal” seizures in the classroom and incorrectly labeled ADHD, rather than epilepsy finally diagnosed when she was in middle school.

    Then came years and years of teachers and administrators breaking the laws regarding that health condition, but that’s for another article on the topic of epilepsy, not ADHD.

    (By the way, this was not in MPS. The original misdiagnoses and malpractice by teachers was in a Waukesha County district, before we moved to the allegedly great Shorewood school district, where the illegal behaviors by teachers and administrators occurred.)

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