Individuals with a gifted/attention deficit/hyperactivity disorder diagnosis

Abstract

This paper reviews the current literature on twice-exceptional students who are dual diagnosed as having giftedness and attention deficit/hyperactivity disorder (ADHD). This area of research is warranted because giftedness and ADHD present similarly but have different ramifications for performance and outcomes. In addition, research inquiry and intervention can ease the frustration of those individuals who have both of these strengths and weaknesses. Giftedness and ADHD are examined in terms of identification of individual and dual diagnoses; performance of gifted students with ADHD, including underachievement and creativity; psychosocial outcomes; and interventions for students with giftedness/ADHD. Gaps in the literature and future directions are discussed.

Keywords

Gifted attention deficit/hyperactivity disorder twice-exceptional

Individuals with a gifted/attention deficit/hyperactivity disorder diagnosis

Individuals who have two exceptionalities—both giftedness and a learning disability—have been neglected in education and research endeavors in the past (Foley-Nicpon et al., 2011; Leggett et al., 2010). One twice-exceptional combination of interest is giftedness and attention deficit/hyperactivity disorder (ADHD). To study, understand, and learn about the gifted/ADHD population can prepare these individuals, as early as possible, for a successful future. This dual diagnosis can be frustrating or confusing for individuals who feel they can succeed in certain areas but struggle in others. With more knowledge about the gifted/ADHD population, their academic and psychosocial burden may be eased. Multiple articles take up the topic of twice-exceptional students, children, and adults (Baum and Owen, 1988; Morrison and Rizza, 2007). However, these articles only use the broad definition of giftedness/learning disability. The participant criterion in these studies is loose, and some studies encompass several learning disabilities. Although the broad twice-exceptional research is warranted for twice-exceptional learners, this paper will focus on the gifted/ADHD population specifically, unless otherwise noted. We aim to review four main areas of concern for gifted/ADHD population: identification, performance, outcomes, and intervention. Gaps in the literature will be highlighted and coupled with relevant future directions.

Identification of attention deficit/hyperactivity disorder, giftedness/attention deficit/hyperactivity disorder

Controversy surrounds the identification and diagnosis of ADHD, giftedness, and the dual diagnosis of gifted/ADHD. Specifically, ADHD may be over-diagnosed (Sciutto and Eisenberg, 2007), the definition of giftedness is broad and somewhat vague, and the diagnosis of gifted/ADHD has the easy potential for misdiagnosis. In order to understand the dual diagnosis of giftedness/ADHD, each diagnosis and accompanying symptoms should first be individually understood and then compared.

Attention deficit/hyperactivity disorder

The Diagnostic and Statistics Manual of Mental Disorders-Fifth Edition (DSM-5; American Psychiatric Association, 2013) characterizes ADHD as a pattern of inattention and hyperactivity/impulsivity behavior experienced across multiple settings prior to the age of 12. The DSM-5 has changed to include adult ADHD diagnosis (over the age of 17) in the latest revision. Individuals can be diagnosed with three subtypes: Predominately Inattentive, Predominantly Hyperactive/Impulsive, or Combined Inattentive/Hyperactive.

ADHD has grown in popularity in recent years and is known as the “diagnosis of the decade” (Webb et al., 2005). The current prevalence rates for ADHD range from 3% to 11% (American Psychiatric Association, 2000 [3–7%]; American Psychiatric Association, 2013 [5%]; Kessler et al., 2006 [4.4%]; Polanczyk et al., 2007 [5.29%]; U.S. Department of Health and Human Services, 2012 [9%]; Visser et al., 2013 [11%]). Over-diagnosis of ADHD is a controversial topic due to the large increase in prevalence. Sciutto and Eisenberg (2007) attribute falsely diagnosing ADHD to the comorbidity to other diagnoses, diagnostic inaccuracies, and changes in diagnostic criteria. Other reasons for the increase in diagnosis may be more awareness of the existence of the disorder, the measures/methods used in the diagnosis, and socio-economic status (Graham et al., 2007; Wendling, 2012).

Currently, several ways to identify and diagnose ADHD are practiced. Some health professionals rely on checklists given to parents and teachers, or administered by the professional him- or herself (e.g., Connors Rating Scales-CRS, Behavior Rating Inventory of Executive Function-BRIEF, Vanderbilt Assessment Scale-NICHQ). There are also specific assessments that measure attention and memory (e.g., Test of Everyday Attention-TEA, Test of Variables of Attention-T.O.V.A., Continuous Performance Tests-CPT). Finally, some mental health professionals administer a series of test batteries, also including intelligence testing. These assessment measures vary widely in how physicians and clinicians diagnose ADHD because they operationalize the disorder differently based on these different measures and are administered by different kinds of professionals.

Giftedness

Defining giftedness is controversial: it is a broad concept that ranges in definition from high intellectual ability to rarities in several different life components (Webb et al., 2005). The National Association for Gifted Children defines the gifted as, “those who demonstrate outstanding levels of aptitude or competence in one or more domains. Domains include any structured area of activity with its own symbol system and/or set of sensorimotor skills” (National Association for Gifted Children, 2008b). The federal definition according to The Jacob Javits Gifted and Talented Students Education Act is “children and youths who give evidence of higher performance capability in such areas as intellectual, creative, artistic, or leadership capacity, or in specific academic fields, and who require services or activities not ordinarily provided by the schools in order to develop such capabilities fully” (U.S. Department of Education, 2012).

Due to the ambiguous nature of the definition, identifying students who are gifted is complex. The most obvious way to identify gifted students is through intelligence tests. Those who have a score of 120 or higher (i.e., more than one standard deviation from the mean) are usually identified as intellectually gifted. Creativity, another form of giftedness, is usually assessed through the Torrance Tests of Creativity (Kim, 2006; Lissitz and Willhoft, 1985), a standardized measure of creativity for visual and written mediums. Finally, other assessments are available in the form of teacher and parent rating forms, in which, for example, learning, creativity, motivation, leadership, artistic, and musical topics are examined (e.g., the Scales for Rating the Behavioral Characteristics of Superior Students).

Similarities of giftedness and ADHD

Gifted students and students who have ADHD have certain behaviors in common that can be mistaken for one another. For example, individuals with ADHD and individuals who are gifted may have problems in fidgetiness and inattention, off-task behaviors, high activity levels, and some disobedience of authority (Latimer and Webb, 1993). Although these behaviors are similar, the conditions and causes are different. Students who are gifted may display inattention, fidgetiness, and off-task behaviors because they are bored in school and are not challenged. These behaviors typically do not manifest in all settings for gifted students. In contrast, students who have ADHD display these behaviors in multiple settings, including home and educational situations. Gifted students may exhibit high activity and focus on topics that spark their interest, while students with ADHD present as hyperactive regardless of interest. Finally, students with ADHD may not understand rules or be able to follow through with instructions. Gifted students with a higher intelligence may question authority, especially if the authority figure limits the interests of the gifted student (Antshel, 2008; Hartnett et al., 2004; Latimer and Webb, 1993).

Creativity and ADHD also have similar symptoms: inattention, hyperactivity, and impulsivity. Much like the confluence of high intellect and ADHD, creative individuals may display these symptoms because they focus on specific creative interests, are highly active in their own chosen work, and often take risks (for a review, see Cramond, 1995).

Dabrowski’s theory of overexcitabilities offers one explanation why gifted students display ADHD-type symptoms (Dabrowski, 1967; Flint, 2001; Mendaglio and Tillier, 2006). Dabrowski stipulated five responses to stimuli that are above average: psychomotor, sensual, intellectual, imaginational, and emotional. In a number of different studies, gifted students were found to have intellectual, imaginational, and emotional overexcitabilities (for a review, see Mendaglio and Tillier, 2006). These three overexcitabilities associated with giftedness may include heightened activity of the mind (intellectual), distractibility and daydreaming (imaginational), and strong feelings (emotional), all of which are similar to ADHD symptoms.

The similarities of behaviors may lead to a diagnosis confused between giftedness and ADHD. Hartnett et al. (2004) provided a vignette with many of these behaviors and discovered depending on how the diagnostic vignette was presented, first-year graduate students in a counseling psychology program diagnosed ADHD or giftedness differently. Specifically, if not given any directive, giftedness was not diagnosed at all; however, when given the suggestion of giftedness, 46% of the participants diagnosed giftedness or a combination of giftedness/ADHD. Rinn and Nelson (2008) replicated the study with 132 pre-service teachers and found similar results: without any prompting, giftedness was neglected as a diagnosis of the child in the vignette. The counselors and teachers’ first impulse was toward pathology rather than talent.

Another misdiagnosis problem occurs when the strength or disability of the twice-exceptional individual hides or masks the other diagnosis (McCoach et al., 2001). McCoach and colleagues (2001) highlight three possibilities: firstly, a twice-exceptional individual may be labeled as gifted but not as learning disabled because their strengths mask the disability. Secondly, an individual may be identified as having a learning disability but is not identified as gifted because of poor performance outcomes based on the disability. Thirdly, an individual performs within normal range at school because the strength and disability cancel each other out behaviorally; therefore, the student remains unidentified in both the strength and disability.

Due to the high probability of misdiagnosis for individuals with giftedness/ADHD, many authors caution against preemptively diagnosing a child without multiple sources and assessments (Baum and Olenchak, 2002). Baum et al. (1998) suggest that if a gifted assessment is given and later a learning disability is discovered, the student should again be assessed for giftedness.

Vignettes and case studies have dominated the articles about individuals who are gifted/ADHD. Although the anecdotal information to characterize students who are gifted/ADHD is helpful, empirical studies show significant differences between giftedness, ADHD, and the combination of giftedness/ADHD. The next two sections focus on empirical studies assessing the performance and psychosocial outcomes of individuals with gifted/ADHD.

Performance of gifted students and students with attention deficit/hyperactivity disorder

Some research has found that twice-exceptional students perform similarly to their gifted peers in terms of intellectual ability, but perform poorly in academic areas, where they are more similar to the learning disabled population (Nielsen, 2002). However, there have been no researched studies in the ADHD subpopulation with these types of comparisons. This section identifies the literature on the performance of gifted students, students with ADHD, and students who have a dual diagnosis of gifted/ADHD.

Executive functioning deficits or challenges are typically observed in individuals with ADHD. Executive functioning is the processes coordinated in the brain to link past thought and present action (Funahashi, 2001; National Center for Learning Disabilities, 2014).

Deficits in executive functioning include problems with vigilance, fluency, planning, working memory, inhibition, and set shifting (Boonstra et al., 2005; Corbett et al., 2009; Pennington and Ozonoff, 1996). In a study assessing gifted adults who had ADHD, Brown et al. (2009) discovered significant weaknesses in the areas of processing speed, working memory, and auditory verbal working memory, which is consistent with ADHD executive functioning deficits. These adults with gifted/ADHD were compared against the standard sample of the measures; unfortunately, a sampled comparison group was not collected and used.

In other studies using control groups, differences emerged for students who were gifted/ADHD compared to those who were non-gifted but had ADHD or were gifted but did not have a diagnosis of ADHD (Antshel et al., 2007, 2010; Fugate et al., 2013; Healey and Rucklidge, 2006; Zentall et al., 2001). Children who had giftedness/ADHD, compared to gifted-only controls, performed worse on several executive functioning tasks, including the Freedom from Distractibility factor of the Wechsler Intelligence Scale for Children-Revised (WISC-R), the Wisconsin Card Sorting Test, and a continuous performance task (Antshel et al., 2007, 2010). The results from the Freedom from Distractibility factor (i.e., Digit Span and Arithmetic) on the Wechsler tests should be interpreted carefully: it has shown validity for assessing ADHD when using group-averaged scores but not at the individual child level (Anastopoulos et al., 1994). Working memory on the Woodcock Johnson III Normative Update Tests of Cognitive Abilities (WJ-III COG NU) was also found to be significantly lower for adolescents who have gifted/ADHD compared to gifted-only controls (Fugate et al., 2013).

Compared to non-gifted control students with ADHD, children with gifted/ADHD performed better on the T.O.V.A., a continuous performance test. Children who have a dual diagnosis made fewer omission and commission errors, and displayed a heightened sensitivity (Chae et al., 2003). Omission errors occur when the individual does not press the button when they see the correct stimulus and commission errors occur when the individual presses the button when they are not supposed to and do not see the current stimulus. Heightened sensitivity “reflects the ratio of the hit rate to the false-alarm rate” (Chae et al., 2003: 194). There were no differences between ADHD/gifted and ADHD/non-gifted for response time and response time variability in the Chae and colleagues (2003) study.

Zentall and colleagues (2001) used a case study design to investigate differences between boys identified as gifted/ADHD, non-gifted/ADHD, and gifted/non-ADHD, with three cases for each category (N = 9). They found in their case study sample that the gifted/ADHD boys had issues with starting, organizing, and sustaining attention for assignments and homework. Again, these symptoms are consistent with an ADHD diagnosis; those who have ADHD have difficulties with organization and sustained attention (American Psychiatric Association, 2013).

Healey and Rucklidge (2006) did not use formal ADHD diagnoses, instead opting to use parent and teacher ratings of the Conner’s Rating Scales-Revised to measure ADHD symptomology. Despite this limitation, Healey and Rucklidge (2006) found that creative individuals with ADHD and creative individuals without ADHD performed similarly on Full Scale IQ from the Wechsler Intelligence Scales for Children, 3rd edition (WISC-III), working memory, and executive functioning, and both groups performed better than the non-creative ADHD individuals. In addition, creative individuals with ADHD scored in between the non-creative/ADHD and creative/non-ADHD on processing speed, reaction time, and naming speed. The authors suggested these results show that the individuals who had creative/ADHD tendencies were somewhat impaired on these processes compared to similarly creative students (Healey and Rucklidge, 2006). In contrast, Fugate and colleagues (2013) found that adolescents who were diagnosed with giftedness/ADHD had a greater creative potential than just gifted adolescents. The authors explained that 41% of the group of gifted/ADHD scored at or above the 90th percentile on the Creativity Index on the Torrance Tests of Creative Thinking.

A commonly cited potential problem for twice-exceptional students is underachievement (Lupart and Pyryt, 1996; Reis and McCoach, 2000). It is well documented that students with ADHD (Barry et al., 2002; Hinshaw, 1992a, 1992b) and gifted students (McCoach and Siegle, 2003; Reis and McCoach, 2000) have the potential to be underachievers. Lupart and Pyryt (1996) noted that gifted students in subpopulations (such as ADHD) might not obtain the appropriate intervention because underachievement is treated as two separate problems (i.e., a gifted program issue or an ADHD program issue). In fact, only one empirical article mentions underachievement of students who have gifted/ADHD. Zentall and colleagues (2001) noted in their case studies that students with giftedness/ADHD and students with ADHD both demonstrated underachievement. They noted that teachers commented about the subjects’ not meeting their potential (Zentall et al., 2001). No other article found focused on the intersection of giftedness and ADHD in terms of underachievement.

Outcomes for gifted individuals and individuals with attention deficit/hyperactivity disorder

Besides performance, psychosocial outcomes and life effects of individuals with giftedness/ADHD are important to gauge functioning. Research has provided a glimpse of outcomes for individuals who have a dual diagnosis of giftedness and ADHD. Four outcome topics arise in the current literature: academic, mood and emotional, life satisfaction, and functional/behavioral outcomes.

Academically, children and adults who have giftedness and ADHD were more likely than gifted-only students to need academic tutoring (Antshel et al., 2007, 2009). In addition, children who are gifted/ADHD are more likely than gifted controls to have to repeat a grade and to be placed in special education settings (Antshel et al., 2007). Finally, Zentall and colleagues (2001) found both groups of children with ADHD were underachievers, consistently disliked or hated homework, and reported preference in working with others. Both gifted groups (i.e., gifted-only and gifted/ADHD) showed preferences for challenges, pressure, and competition.

Children who were gifted/ADHD had more emotional difficulties and intensity compared to gifted/non-ADHD and non-gifted/ADHD (Zentall et al., 2001), and children and adolescents who had a gifted/ADHD diagnosis had lower self-reported positive self-esteem and self-concept about their behavior compared to gifted-only controls (Foley-Nicpon et al., 2012). In terms of mood, children who had a gifted/ADHD diagnosis had higher rates of mood, anxiety, and disruptive disorders compared to gifted-only controls (Antshel et al., 2007). Similarly, adults who were gifted/ADHD had higher rates of major depressive disorder, generalized anxiety disorder, and obsessive-compulsive disorder compared to gifted controls (Antshel et al., 2009). Antshel and colleagues (2009) found adults with gifted/ADHD diagnoses did not have problems with substance abuse disorder, alcohol abuse, or antisocial personality disorder, which is counter to the research on substance abuse in adults who have ADHD (Charach et al., 2011). The authors suggested that a high intellect might be a protective factor against these disorders.

Overall, life happiness seems to be lower for individuals who have gifted/ADHD compared to gifted controls (Antshel et al., 2009; Foley-Nicpon et al., 2012). Specifically, children and adolescents who had gifted/ADHD reported less overall happiness, and adults who had gifted/ADHD reported lower quality of life rating in multiple domains, including home, work, and social areas. They also reported lower sense of well-being and lower overall life satisfaction (Antshel et al., 2009).

Functional outcomes were also worse for children who had gifted/ADHD labels compared to gifted controls. Children who had gifted/ADHD had higher impairments in relationships with peers, the opposite sex, and parents. Behavior problems at school and in spare time were also worse for children with gifted/ADHD diagnoses (Antshel et al., 2007; Moon et al., 2001). See Table 1 for a summary of gifted/ADHD outcomes.

Table 1.

Summary of gifted, attention deficit/hyperactivity disorder (ADHD), and gifted/ADHD outcomes.

Gifted controls	Giftedness/ADHD	ADHD control
Academics
Control	More likely to need academic tutoring^a,b	No comparison group
Control	More likely to repeat a grade^a	No comparison group
Control	More likely to be placed in special education classes^a	No comparison group
Control	Underachievers disliked/hated homework^e	Underachievers disliked/hated homework
Control	Preference in working with others^e	Preference in working with others
Preference for challenges, pressure, and competition	Preference for challenges, pressure, and competition^e	Control
Mood/emotions
Control	More intense emotions^e	Control
Control	Lower self-reported positive self-esteem and self-concept^c	No comparison group
Control	Higher rates of mood, anxiety, and disruptive disorders^a	No comparison group
Control	Higher rates of major depressive disorder, generalized anxiety disorder, and obsessive-compulsive disorder^b	No comparison group
No comparison group	No substance abuse, alcohol abuse, or antisocial personality disorder^b	No comparison group; based on previous research
Life satisfaction
Control	Lower overall happiness^b,c	No comparison group
Control	Lower quality of life in multiple life domains^b	No comparison group
Control	Lower sense of well-being^b	No comparison group
Control	Lower overall life satisfaction^b	No comparison group
Functional/behavioral
Control	Higher impairments in relationships with peers, opposite sex, and parents^a	No comparison group
Control	Behavior problems in school and in spare time^a,d	No comparison group

^a Antshel et al. (2007)

^b Antshel et al. (2009)

^c Foley-Nicpon et al. (2012)

^d Moon et al. (2001)

^e Zentall et al. (2001)

Intervention for gifted/attention deficit/hyperactivity disorder students

Established interventions and research for students with giftedness (Walsh et al., 2012), students with ADHD (Langberg et al., 2013), and twice-exceptional students (Baum, 1988; Olenchak, 1995; Reis et al., 2000) are present in the literature; however, there is a lack of research in empirical interventions for the gifted/ADHD subpopulation. The majority of the articles describing techniques are review articles that do not provide support for or against these interventions. In addition, the interventions suggested are broad strategies that most likely would apply to all students—not just students who are gifted/ADHD. The interventions given are predominately educational in setting, although there are some techniques and strategies for reducing home, social, and emotional stress (Flint, 2001; Leroux and Levitt-Perlman, 2000).

In a case study, Zentall and colleagues (2001) found the most helpful motivational advantage for the male children with gifted/ADHD was a teacher who provided individual attention and took a personal interest in the students and their work. For gifted and non-gifted children with ADHD, Zentall and colleagues found that shorter assignments with more directions (e.g., asking the child to underline important facts, using tape recorders for directions, reminding students of directions, checking the child’s comprehension of the directions) and feedback (e.g., making regular checkpoints, providing self-correcting tasks, monitoring progress on long-term projects) helped them learn. Involving the students in helper or leadership activities, increasing the communication with parents, and using incentives to finish work also seemed to help (Zentall et al., 2001). For gifted children with or without ADHD, Zentall and colleagues (2001) found that encouraging questions, helping the child to think of cognitive processes in a structured method, and providing challenging topics were useful strategies.

Other educational interventions and strategies have been proffered without any evidence or support. Many of these strategies seem vague and not necessarily geared toward students with giftedness/ADHD. These suggestions should thus be interpreted and disseminated with caution. Realistic expectations should be provided by the teacher, and these authority figures should teach students to set realistic expectations for themselves (Ramirez-Smith, 1997; Winebrenner, 2003). To facilitate this, structure and standards should be set so children can recognize their freedom and limits (Flint, 2001; Ramirez-Smith, 1997). Teaching organizational strategies and imposing the organizational techniques until learned is recommended (Flint, 2001; Winebrenner, 2003), and in teaching concepts, Winebrenner (2003) recommends teaching the larger concepts first, then the details. She also emphasizes connecting new materials to past content. Finally, assignments and learning opportunities can be made easier and stimulating by incorporating technology and the five senses in interactive projects (Ramirez-Smith, 1997; Winebrenner, 2003).

For parents, understanding that there are no quick fixes, some tactics are using humor to defuse stress and anger with children, providing opportunities to express creativity, emphasizing extra-curricular activities, and finding more time for children to interact with like-minded peers (Antshel, 2008; Flint, 2001). Building self-esteem is critical for these children (Leroux and Levitt-Perlman, 2000; Ramirez-Smith, 1997), especially based on the research presented previously on negative outcomes (Antshel et al., 2009; Foley-Nicpon et al., 2012). Winebrenner (2003) also recommends teaching students to appreciate their individual differences, which may help in the building of self-esteem. Finally, counseling and social skills training may be necessary (Leroux and Levitt-Perlman, 2000).

Gaps in the literature and future directions

Although the articles reviewed give the field a glimpse into the processes and outcomes of individuals who are gifted/ADHD, several elements are missing in these articles and in the gifted/ADHD field. Three major sections are of note: defining constructs, the current gifted/ADHD literature, and lack of empirical articles.

Defining constructs

As mentioned previously, the definitions and identification of giftedness and ADHD are controversial. Most of the articles reviewed classify individuals as gifted by their intelligence scores. Except for a few empirical articles (Fugate et al., 2013; Healey and Rucklidge, 2006), creativity is almost non-existent as a giftedness construct. Artistic giftedness is also not mentioned in these studies. It is unknown at this time whether creative or artistic gifted students with ADHD behave similarly or different than intellectually gifted students with ADHD. To truly understand the interaction of giftedness and ADHD, research on creatively and artistically gifted individuals is necessary.

Another issue is the use of intelligence quotient to identify giftedness (most are IQ scores greater or equal to 120 or 130). This score may be misleading because many of the IQ tests used, including the Wechsler tests, contain a working memory and processing speed component. Individuals who have a dual diagnosis of gifted/ADHD may obtain an artificially low IQ score because the ADHD symptoms pull the working memory and processing speed lower (Antshel, 2008). In addition, subtests that encompass the Freedom from Distractibility factor could deceptively reduce the overall IQ score (Anastopoulos et al., 1994).

The formal diagnosis of ADHD should be used in future studies examining individuals with giftedness/ADHD, not only ADHD symptomology. Healey and Rucklidge (2006) and Fugate et al. (2013) used children who had significant parent and teacher ratings of ADHD symptomology. This research method may be flawed, however, when examining giftedness/ADHD because of the similarities in the symptoms of both diagnoses. If gifted students also demonstrate ADHD-like qualities, then ADHD symptomology questionnaires become misleading. Future research should use stricter standards for the inclusion of participants.

Current gifted/ADHD literature issues

For the current literature, the research as a whole does not provide consistent comparison groups. Some studies compare individuals who have gifted/ADHD with a gifted control or ADHD control, but only a few studies (Healey and Rucklidge, 2006; Zentall et al., 2001) examined individuals who have gifted/ADHD versus gifted controls and ADHD controls. A comparison of all three groups is necessary because with only one control, the contrast between the single and dual diagnosis is influenced by the second diagnosis only. Therefore there is limited generalizability in the results of these articles.

A second problem for the current literature is the inconsistency between articles in the cut-off scores in intelligence tests for giftedness. Giftedness is typically identified through intelligence scores. However, the current literature does not have a consensus of what that cut-off should be. The majority of articles cut off the scores at 120 or higher (Antshel et al., 2007, 2009, 2010; Brown et al., 2009; Foley-Nicpon et al., 2012), but one used a cut-off of 130 (Chae et al., 2003). Others used different criteria such as grade point average and achievement scores (Fugate et al., 2013; Moon et al., 2001; Zentall et al., 2001). Comparisons between articles must be interpreted with caution due to this inconsistency in operationalizing the giftedness term.

The final note on the current literature concerns the ADHD side of individuals with gifted/ADHD. No articles in this review differentiated in their results between the subtypes of ADHD. Since there are different symptoms between the Predominantly Inattentive Subtype and Predominantly Hyperactive/Impulsive Subtype, more research should focus on these distinctions.

Lack of empirical articles

The lack of empirically based articles for gifted/ADHD students is a major concern in this line of research. The larger pool of articles for twice-exceptional children encompasses many disorders, such as ADHD, learning disorder, dyslexia, emotional disturbance, and others. Although concern about twice-exceptional children is more evident now than in the past, children who have gifted/ADHD may exhibit different symptoms and may grow with specifically targeted interventions.

The authors of this article did not find any empirically supported interventions for gifted/ADHD students. Fortunately, several empirically supported interventions for twice-exceptional individuals (Baum, 1988; Olenchak, 1995; Reis et al., 2000) have been successful. A more focused and selected intervention regarding the ADHD disability has not been examined, but is warranted.

A large gap in the literature is educational intervention with teachers on the symptomology of the disorders. What is missing is a focus on helping teachers understand and learn the symptoms and interventions for these dual diagnosed students. This is especially important in light of the work of Hartnett et al. (2004) and Rinn and Nelson (2008). These studies demonstrated defective identification of giftedness/ADHD by counseling students and pre-service teachers. Future research should focus on the professional’s side of the matter. Most of the interventions discussed in the literature are helpful, but not specific to the gifted/ADHD subpopulation. Instead, these interventions appear to apply to all students and should be instituted school-wide.

Finally, all studies reviewed had a cross-sectional design. Longitudinal research would help the field understand long-standing implications and outcomes of any strengths or difficulties for people with a dual diagnosis in childhood.

Conclusion

In conclusion, individuals who have a dual diagnosis of gifted/ADHD are in danger of misdiagnosis, poor performance, and psychosocial outcomes, with few empirically supported interventions geared toward their specific disability. Several areas have not been examined in the research field, including artistically gifted students with ADHD, subtypes of ADHD, and longitudinal work with individuals who have giftedness/ADHD. In order to successfully help these individuals, a more focused line of inquiry is needed.

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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