Please, please be sure!

Trevor J. Tebbs Ph.D. 

This article seeks to alert readers to some immensely important information rarely imparted when ADHD is being considered by teachers, school psychologists, medical doctors, psychiatrists, and others.

 

Parents and teachers over the past few years have been subjected to advertisements and articles relating to ADHD (Attention Deficit and Hyperactivity Disorder) in their children.  Current publicity associated with drugs such as Adderal is powerful in its rhetoric and persuasion with respect to what such a drug can do for supposedly inattentive, hyperactive, and impulsive individuals and their academic success.  The drug is evidently popular, it’s sales, back in the last quarter of 2004 alone, amounted to $140 million^[1].  The growth in Adderal sales prompted the producer to seek and obtain a patent to run through to 2018. 

Some experts assure us there is such a condition as ADHD.  I am not an expert in this field: my expertise covers the educational and emotional needs of highly able and gifted children.  I do not advocate teachers and parents dismiss attention or behavior concerns that directly affect a child in his current educational setting.  None are willing for a child to struggle needlessly against any impediments to their learning.  Yet it is imperative that parents and teachers give the issue some very serious consideration before reaching hurried or ill-informed conclusions.  Whether we are parents or teachers with children in a teaching and learning environment, the need to establish the truth about the matter is pressing. This is particularly so if the decision to accept a diagnosis and, therefore, also the consequences of such a diagnosis, may ultimately lead a child down the road towards drugs with potentially mind-altering effects.  This is such a serious matter and worthy of close attention. 

The manual used by psychologists and others to determine ADHD and other disorders, (DSM-IV-TR) officially limits incidence of ADHD to between 3% & 5% of the K-12 population.  Even so, for various, yet-to-be-explained reasons, there has been an increasing tendency towards over-identifying children. Results from studies conducted at the Mayo Clinic^[2] lead researchers conclude that the incidence of ADHD may be minimum of 7.5% although there could be up to 20% of children with this disorder. They also say that boys and children from lower income families are more likely to be diagnosed with ADHD.  Researchers in later studies found the incidence to be nearer 24% and that teachers may over-identify the disorder (Glass & Wegar, 2000)^[3].  Whatever the statistics were or are now, so many conversations relating to a child’s behavior in or out of school include “Oh he or she has ADHD” or something similar.

The other day while supervising an education student on her first observation in a kindergarten, I talked a while with her host teacher.  My student had previously mentioned a little boy who was constantly getting into hot water because of “poor” behavior.  Before the children arrived for school, I asked the teacher about him.  “I understand this little guy is having a problem.” 

 “Oh yes,” she said, “He is not doing his work.  He is out there … not attending – just not doing his schoolwork.  I have told the parents about this.  I think he is ADHD or Asperger’s.  They are having him observed.”

Now this may seem perfectly appropriate at first.  However, consider this.  This little fellow is also accepted as being “smart” and creative.  My student informed me that he was able to work out problems quickly, most of the time he seems eager to learn, he has lots to say about things he is interested in, and when he is interested he is on task.

 While I was talking to the teacher, he came into class   - lively and chatting to another kindergartner.  Without having had the opportunity to examine any of the child’s psychological and educational evaluations, I have no clear idea of what may be happening with this child.  However, from information received about the child from my student, his teacher, and my brief observation of him, I discern enough flags to warn me that ADHD and especially Asperger’s Syndrome may not be an appropriate diagnosis.  The response to my question by his teacher was also significant enough to raise immediate concerns for the ultimate welfare of this child. Why?

Here’s why.  I saw signs of behaviors characteristic of a highly able/gifted, possibly creative individual.  Research studies conducted in the context of giftedness and creativity and my own observations over several years convince me that any headlong rush to judgment with respect to ADHD is not wise^[4]. 

Most parents and teachers express surprise when they learn that the criteria used to define a creative individual overlaps that used to diagnose the disorder.  While visiting one New England school as educational consultant, I watched as forty-two middle school students lined up at precisely 11.00 am at the nurse’s office for a dose of Ritalin. That was 7% of the school population.  When I mentioned the research on creativity, the principal said, “Um … that is very interesting.  These kids are some of our most creative.”  

Table One outlines some of the similarities.

Table One: Overlapping characteristic behaviors observed in ADHD and gifted creative children

Inattention

ADHD	Gifted and creative
Easily distracted	Gifted and creative child - broad range of interests
Often fails to finish things	Shows tendency to play with ideas
Frequently shifts activities	Sometimes losing interest in one to take up another
Lacks attention or concentration	Pays close attention to internal thoughts and visualizations
Daydreams or doesn’t seem to listen	Often preoccupied

 

Hyperactivity

ADHD	Gifted and creative child
Restlessness that prevents one from completing tasks	High levels of normal activity
E   xcessive fidgeting	Restlessness
Difficulty staying seated	Drive towards productivity
Excessive running and climbing	Radiant vitality
Difficulty playing quietly	High, even a surplus of energy, ·         Rapid speech, restlessness, fast games and sports ·         Marked enthusiasm ·         Delinquent behavior ·         Impulsive actions ·         Nervous habits

 Impulsivity

ADHD	Gifted and creative
Frequently calls out in class	Risk taking
Difficulty awaiting a turn	Sensation/thrill seeking
Acts without thinking	Innate temperamental trait of sensation seeking
O ften engages in dangerous activities without considering outcome	Needs to transcend established order into disorder and chaos motivated by restlessness – non-conformist behaviors

 (After Crammond, 1994, 1995. See footnote # 4)

 

           This and other vital information is available to guide parents and teachers as they strive to make a wise and balanced decision regarding any accommodations.  However, this much needed information is rarely taken into account by schools.  My concern is that the public in general and specifically those largely responsible for making a diagnosis and recommending interventions, for whatever reason, fail to take it into account at all.

This is important: if suspicions surface with respect to ADHD (or some other disorder) but the child is identified as, or suspected to be highly able/gifted and creative then the characteristic behavioral traits noted above must be considered before reaching any conclusion.  A second opinion, preferably from an expert in gifted education (sadly – often hard to find), should be a matter of course.

A team of educational, clinical, and neuropsychologists recently published a fascinating book entitled, Misdiagnosis and Dual Diagnosis of Gifted children and Adults (Webb, Amend, Webb, Goerss, Beljan, & Olenchak, 2004)^[5].  This is an extremely valuable and eminently readable publication.  It presents and discusses behaviors and other characteristic traits of highly able individuals that could be perceived as evidence of a wide spectrum of disorders including ADHD, bipolar, OCD, Asperger’s, and depression.  It is particularly worth reading if there is the slightest indication a particular child may be gifted and talented, highly able, or advanced in some way.   The authors provide an insightful list of features typical of highly able individuals but considered incompatible with or contradictory to a diagnosis of ADHD (Webb, Amend, Webb, Goerss, Beljan, & Olenchak, 2004, page 58).

·        Onset coincides with the start of formal schooling

·        Shows selective ability to attend to tasks that are of interest, with intentional withdrawal from tasks that are not of interest

·        Has prolonged intense concentration on challenging tasks of interest with no readily-evident immediate reward

·        Is unaware of environment when interested in a task

·        Is easily distracted by environment when uninterested in a task, but tries to avoid disturbing others

·        Delays response when spoken to, but gives thoughtful response

·        Intentionally fails too finish tasks (especially rote work)

·        Blurts out answers that are generally correct

·        Interruptions of conversation are to correct mistakes of others

·        Can be easily redirected from one activity of interest to another of equal interest

·        Passes attention tests, and can shift attention easily if motivated

·        Returns to a task quickly after being distracted or called off task

 

After 15 years studying highly able young people, I would add to the list: Has a problem finishing tasks especially “meaningless” seatwork.  My meaning? Typically, children who are intellectually and, or creatively advanced, are deeply concerned that work in which they are engaged is challenging, complex, learnable at a relatively fast pace, and preferably “meaningful” i.e., connected with their passions, interests, and pitched at an appropriate intellectual level.

In 1993 a study was conducted on a group of gifted 3^rd and 4^th graders by researchers from the National Research Center on the Gifted and Talented. ^[6]   The focus of the study was to ascertain if these children experienced any appropriate instructional or curricula differentiation in their school activities.  No differentiation was found in 84% of instructional activity.  This is significant because highly able/gifted individuals are likely to be gathering and understanding facts, concepts, and principles in one or two iterations compared with peers who might typically take much longer to master the material.  While waiting for others to “catch-up”, those with active and imaginative minds wander off on some unknown journey of discovery or find themselves distracted or otherwise in a behavioral decline which to the uninformed may appear symptomatic of ADHD.

The issue of a child being ADHD or not, is a matter of great importance. And it is not an issue that disappears after 12^th grade.  I have experienced the frustration, anger, and unhappiness of young people at college and university whose perception of self is highly and negatively distorted because of what appears to have been misdiagnosis of one disorder or another.  Here are some behaviors I have observed in highly able/ gifted postsecondary students diagnosed during their elementary school years with ADHD and prescribed either Adderal or Ritalin.

·Tears in both young men and women

·Obvious stress & anxiety

·Fear of failure

·Indecision & poor decision-making - e.g., election of wrong courses (majors)

·Lack of motivation, commitment, boredom

·Lack of self-efficacy, uncertainty & avoidance of tasks

 ·Sense of despair & depression (talk of giving up, dropping out and worse)

            What is a very real concern is they seem to perceive themselves as “sick” and therefore unable to function in ways that fully match their potential.  They seem to become dysfunctional. This is a truly serious matter for both them and for our society.  Andy, one of the many college freshmen, I have met and talked about this subject, wrote to me:

When diagnosed I was subjected to taking Ritalin and Adderal. These medications affected the way I interacted and still interact with my peers. When I am on this medication, I feel annoyed and have very little patience with the people around me. It also affects the way I focus in school and complete my work. When under the influence of this medication, I feel hyper and uncomfortable, but compelled to complete the task at hand. My opinion is that the negative affects of these drugs outweigh the positive ones, and more studies need to be done on the side affects and long range after-effects following use of these drugs. I would like parents and doctors to be more conservative about handing out and prescribing a drug that reacts like speed to young children and students. Instead of medicating children, we should be looking for alternative methods of helping people like me control and cope with ADHD–like symptoms. We need to educate the teachers in ways to handle students and channel the nervous energy that comes with such disorders. It seems to me, that society and parents are looking for an easy way out on a problem that is much more complex then handing out pills to solve a learning disability such as ADHD. (Personal communication October, 2005)

True, it is important, indeed our responsibility, to ascertain whether an individual is suffering from any underlying issues hindering their learning potential.  True, it is our responsibility to ensure the proper intervention or treatment is provided.  However, before we allow erroneous, stigmatizing labels to be attached to our children, and before we accept delivery of unnecessary, even harmful treatments, let us be sure we have examined all aspects of the issue.  Surely, it is also our responsibility to be certain that our highly able/ creative gifted children are not being denied what they really need in order to facilitate realization of their developmental potential.  Please, please be sure.