It is not very common, but sometimes it happens that children with Attention Deficit Hyperactivity Disorder (ADHD) are also children with high abilities. “The estimated values of this comorbidity are between 2% and 5%, according to the data we have available,” says Eduardo Lázaro Martínez, a neuroeducator specialized in the integration of new information and communication technologies (NTIC) for curricular adaptations and president of the Association of High Abilities of Alava. This is one of the possibilities of what is called double exceptionality. But not the only one. “It can also refer to high abilities with other comorbidities, such as autism spectrum disorder (ASD) or dyslexia. Likewise, it can be called in the same way to cases of ADHD and one or more specific talents, which do not necessarily have to be high abilities,” says the neuroeducator.
ADHD and giftedness are a complex comorbidity: “By definition, they are two opposite characteristics within neurodiversity,” explains Lázaro Martínez. For this specialist in giftedness, the most widespread characteristic of this double exceptionality is the asynchrony between emotional control and intellectual capacity: “This usually translates into emotional management problems, cognitive deficiencies or social interaction problems.”
Child and adolescent psychiatrist Miguel Ángel Calero Marín says that these are children who have a learning capacity that reaches the levels of high abilities and, at the same time, present significant difficulties in specific academic or cognitive areas: “For example, we could see in the minor a great creativity, curiosity and critical thinking, but that, due to their poor organization, they quickly get frustrated with problems or exercises.” In fact, according to him, these minors live with a lot of frustration: “Their creative and logical capacity surprises both adults and teachers, but then their academic results and concentration are not up to par, which leads to thinking that they are lazy or that they are not very motivated.” Calero recognizes that the minor lives victim of an intelligence that does not know how to direct when needed.
Although not all children with double exceptionality respond to the same academic or social patterns, it depends on the type of ADHD they have. “In the subtypes with a predominance of hyperactivity (the other being inattentive), it is more common for them to have conflicts with their peers before the age of 12 due to their impulsiveness,” Calero continues, “because they regulate their motor activity worse than traditional ADHD. On the other hand, some of these children enjoy spending time alone more, focused on their interests. But not because there are problems with socialization, but because there is less interest in it.”
What is foreseeable, according to the child and adolescent psychiatrist, is academic failure: “The combination of high cognitive ability and organizational difficulties leads them to fail courses during primary school and then have a hard time in secondary school, when the study habit is necessary and they have not developed it. In cases with a higher IQ, it can be delayed until high school, where the study habit and discipline become essential for any student,” says Calero. Lázaro, for his part, agrees that ADHD and high abilities share several problems, such as social and learning difficulties, and recognizes that both problems are cumulative.
It is common for low self-esteem to take its toll on these children: “Because of their way of processing the world and solving problems, they often do not fit into the general system of things,” Calero continues. “This can lead them to feel distant or strange. In the case of double exceptionality, frustration can also be greater, since according to the tests they should have academic facilities, but in practice they fail, so the child ends up understanding that it is their fault, which causes direct damage to their self-esteem.”
What can make parents suspicious? One of the clues may come from their academic results. “In class, it will be noticeable due to the disparity in their grades, with excellent results in some subjects, almost without effort; but fair grades in others in which, despite trying, they cannot concentrate,” explains Calero. And he adds: “This possibility must be taken into account if one of their two parents or a sibling has already been diagnosed with ADHD.” Likewise, according to his report, a child who has a great creative capacity, memory or for handling abstract ideas, but who at the same time has motor restlessness and finds it difficult to respect his turn when speaking, could be showing an indicator of this double exceptionality.
Given these possibilities, Calero stresses that if the family has not carried out any assessment, it is interesting to request a study at their educational centre as a first step: “Even more so if one of the first-degree relatives has ADHD. In that case, a neuropsychological evaluation is recommended, not only to detect high abilities, but also other associated difficulties, whether ADHD or not.”
It is not easy to find out whether or not children have double exceptionality because, as Eduardo Lázaro explains, minors with these peculiarities share some behavioural characteristics, which makes the diagnosis difficult or, at the very least, confusing for personnel not specifically trained in the identification of neurodivergences: “On the other hand, the development of children with high abilities is not typical and, depending on the field of exceptionality of each one, we can find unusual interests and behaviours. Therefore, the use of specific tests, not only of high abilities, but also of attention, the knowledge of the specific circumstances of the minor and the follow-up of the case for at least six months are key to the correct diagnosis.”
The role of parents
For parents, raising a child with twice-exceptionality is, in the words of child and adolescent psychiatrist Miguel Ángel Calero Marín, a double challenge, because in some areas of their life, such as scheduling, there is a tendency to look for more demanding or extracurricular plans to enrich them: “And in other more day-to-day areas, for example, something as simple as brushing their teeth, we will have to show them constant positive reinforcement, use some facilitator in the home environment as reminders, and positive discipline for when they do not fulfill their responsibilities.”
“As parents, we must strive to see them as they are and not as we want them to be. Beyond their double exceptionality, they are still children with a future to write and a path full of light and shadow,” says Calero. For the psychiatrist, parents must be able to adapt to their manias, their hopes, their fears and their dreams. That is the key to a happy upbringing.
According to neuroeducator Eduardo Lázaro Martínez, president of the Association of High Abilities of Álava, it is also essential to remain calm and use a lot of patience and understanding, as well as affection and love. The expert recommends making an effort to understand what is happening to these children and to know what they are facing, so he recommends going to a neurodevelopment specialist, getting information from a professional and not through the Internet or non-specialized sources. In this way, for example, parents will take into account additional difficulties that their children will face: “The high self-demand, frustration, asynchrony between capacity and emotional control… are food for a low self-concept.”
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