ABSTRACT
According to Gordon (1990), far too many high ability students are referred for problems with impulsivity, hyperactivity, and sustaining attention. Several important issues, rarely discussed in the literature on attention deficits, offer alternative hypotheses for the increasing incidence of hyperactivity and attention problems of gifted youngsters. These include theories on emotional development and excitability of gifted students (Dabrowski, 1938; Piechowski & Colangelo, 1984), evidence of unchallenging curricula (Reif, 1993), implications of the multiple intelligences paradigm (Gardner, 1983), and adult reaction to students’ extreme precocity (Rimm, 1994). These issues are examined in light of Barkley’s theory of inhibition as it relates to the manifestation of ADHD. The issues represent environmental conditions that may cause or influence ADHD-like behaviors in high ability students. Diagnostic and intervention strategies are suggested to counteract environmental contributors to the problem.
A master of Lego™ bricks, verbally precocious Chris is failing miserably at school. Despite an estimated IQ of 172, he was retained in first grade because of failure to complete work and poor motor and social skills for his age. In second grade, his teacher referred him for special education screening because of his impulsive and disorganized behavior. Chris was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).
Referrals for attention disorders among gifted children have been growing at an unexpected rate (Webb & Latimer, 1993). Although the increases alone are troublesome, there is additional concern because of professionals’ lack of clear definitions for ADHD, giftedness, creativity, and a variety of other behavioral characteristics (Cramond, 1994; Jordan, 1992; Piechowski, 1991). Diagnosis of ADHD sweeps across a number of problematic behaviors such as impulsivity and hyperactivity, in addition to a collection of deficits in concentration, persistence for tasks, organization of thinking, and focusing attention. Such varied aspects of ADHD have prompted some researchers to claim that most gifted students with learning disabilities also demonstrate behaviors associated with ADHD (M. Cherkes-Julkowski, personal communication, March 9, 1993).
The most frequently prescribed intervention for ADHD is medication in the methylphenidate family, usually Ritalin-AE. Medications are usually successful in controlling behavior, but they are also suspected to inhibit creativity and intellectual curiosity in bright children. Anecdotal reports tell of gifted youngsters being ‘cured of their giftedness’ in an effort to help attend to schoolwork. As Cramond (1994) put it, perhaps we are lucky that medication was not available to stop the daydreams of Robert Frost and Frank Lloyd Wright (p. 205). No conclusive research exists to explain the impact of such medication on various thought processes, including those related to potentially creative, productive thinking. Perhaps even more worrisome is that the behaviors thought to signal a disorder might sometimes be the result of an environment where bright but reluctant youngsters are expected to conform to a sluggish and boring curriculum.
The predicament of inattentive gifted youth has several important implications. First, the loss of valuable human resources comes at a time when the world depends increasingly on its brightest and most creative youth to assist in resolving the problems of tomorrow. If we cannot design appropriate interventions that will nurture human potential, much of the world’s best human capital will never reach its potential. A second concern is for lost achievement. Unfortunately, even when medication is appropriate to assist in behavior management, underachievement often continues (Lind & Olenchak, 1995). School administrators occasionally exacerbate the situation by viewing ADHD purely as a medical problem, thereby absolving themselves, teachers, and school curricula from responsibility. Parents, too, can excuse their child’s inappropriate behaviors rather than providing the support and structure some of these students need to practice academic and behavioral self-regulation (Zimmerman, Bonner, & Kovach, 1996). Medical professionals admit that if schools were more receptive to individual learning needs of students and were more cognizant of ADHD and its various treatment options, a number of children would not need medication (Barkley, 1990). Educators who are successful with bright but active youngsters argue that schools should be held accountable for providing appropriate educational options for these students (Reif, 1993). Whether medical or educational, the dilemmas are enormous for families confronted with rearing bright children who have ADHD. A spokesperson from the Association for the Education of Gifted Underachieving Students reported that the majority of inquiries received are from frustrated parents of gifted/ADHD students seeking information and strategies to help their youngsters (L. Baldwin, personal communication, November 12, 1996). The two excerpts that follow illustrate the frustration and pain faced by the parents of bright students whose school experiences have been dismal:
1. My son is 15 and has just been diagnosed with attention deficit disorder without hyperactivity. He has been steadily failing subjects since seventh grade even though his IQ is 130. We need help to restore his self-esteem and confidence. He has shown moments of brilliance since he was little, especially in any art or spatial design activity such as building with Legos™ and other structures. But any real blossoming has been shut down by his feelings of failure and years of people — teachers, counselors, and yes, his parents — telling him he is being lazy. We need help in learning how to parent so we are helpful and not harmful to our son.
2. I am a parent of two children, a girl of 15 and a boy of 12, both of whom have tested in the gifted range of intelligence and both of whom have some learning disabilities. Both have been diagnosed as having an attention deficit disorder. My daughter has poor organizational skills as well as a memory weakness and weak fine-motor integration skills. My son also has difficulty in reading with weaknesses in decoding. I am looking for ways in which I can circumvent their disabilities and stimulate them intellectually. It has been difficult getting the schools to recognize their difficulties. Some teachers have been cooperative and others have not. The school system doesn’t recognize their attention deficit disorder as a disability. So much time is being wasted trying to find the right people to help. The process has been trial and error without success (L. Emerick, personal communication, April 17, 1994).
Contemporary educators do not seem to have appropriate strategies, knowledge, or confidence in providing an appropriate education for gifted students with learning and attention difficulties. As mentioned by one parent, some districts dodge their legal responsibility for providing an appropriate education for such students. Although the medical profession has long recommended medication as a primary approach to the problem, educators are provided little direction about the nature and types of educational solutions that are also required.
The most serious concern is that gifted behavior is sacrificed for more manageable behavior in some creative, bright students who are medicated for ADHD. Highly able students with problems in attention, hyperactivity, and self-regulation remain at risk for developing their potential. However, it remains unclear whether these attention deficit behaviors are due to a neurological problem affecting learning, are the result of a learning environment inappropriate for such exceptional learners, or are a combination of both. The complexity of the problem motivates the development of a bio-psycho-social systems model to improve the theory, research, and educational response. Such a model should help to keep many gifted learners from falling through the cracks of the floorboards scaffolding the educational bureaucracy.
In this article, we explore unique issues of attention deficit disorders among gifted students and offer alternate explanations for the occurrence of those behaviors among some students. We first distinguish among three groups of students who demonstrate behaviors associated with ADHD: (a) students whose learning and attention problems stem, for the most part, from a neuro-chemical disorder; (b) those whose behaviors are mostly brought about, and perhaps intensified, by the learning environment; and (c) those who fall into both of the preceding categories.
In addition, suggestions are offered for determining whether the behaviors are primarily environmental, essentially neurological, or both. Finally, we share an approach our research has found to be particularly helpful for combating ADHD-like behaviors that are precipitated by the environment.
WHAT IS AN ATTENTION DEFICIT DISORDER?
Children with Attention Deficit Hyperactivity Disorder (ADHD), according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994), have problems sustaining situation-appropriate attention. These problems can include hyperactivity, alertness, arousal, and distractibility. Some researchers claim that the attention problems are exacerbated by tasks that are dull, repetitive, and boring (Barkley, 1990; Luk, 1985). Impulsivity, academic difficulties, and poor motor skills are other behaviors characterizing children with ADHD. Children with ADHD frequently fail to complete assignments in school or at home, exhibit disruptive behavior in the classroom, and have difficulty relating to their classmates. A majority of these students have learning deficits in spelling, math, reading, and handwriting (Barkley).
Despite current media fascination, this syndrome is not a recent invention. It had been noted in psychiatric literature as early as the mid-1800s. Its emergence in this century began with the appearance of Strauss and Lehtinen’s (1947) book, Psychopathology and Education of the Brain-Injured Child. In the 1950s and 1960s, children who were of at least average ability and who exhibited certain symptoms were identified as having Strauss’ Syndrome, or minimal brain damage, because theorists and researchers of that era believed the behaviors represented some injury to the brain. Characteristics associated with Strauss’ Syndrome included erratic and inappropriate behavior on mild provocation; increased motor activity; poor organization of behavior; distractibility of more than ordinary degree under ordinary conditions; persistent faulty perceptions; persistent hyperactivity; and awkwardness and consistently poor motor performance (Stevens & Birch, 1957).
In the 1970s, professionals dropped the brain injury-behavior link because these connections were virtually impossible to verify, and they focused instead on labeling the set of behaviors as the Hyperactive Child Syndrome. In the early 1980s, psychologists redefined the disorder by de-emphasizing the role of hyperactivity as the primary symptom of the disorder and elevating the importance of one’s ability to sustain attention and to control impulses. Some students, it was noted, were not particularly hyperactive but rather seemed to ‘drift off’ during lectures, reading assignments, and written tasks. This led to the emergence of two terms to describe these children as those who had either Attention Deficit Disorder (ADD) with Hyperactivity or ADD without Hyperactivity (American Psychiatric Association, 1980).
Today, researchers have returned to an earlier focus by re-labeling the syndrome as Attention Deficit Hyperactivity Disorder (ADHD). This label reflects the position that hyperactivity along with problems sustaining attention and controlling impulses are the primary symptoms of the disorder. Theorists do not deny that some children experience attention deficits without hyperactivity, but they argue it may be an altogether different syndrome (Carlson, 1986).
Many theories about the causes of the problem are currently being investigated. There is consensus about genetic and physiological predisposition to the disorder (Barkley, 1995; M. Cherkes-Julkowski, personal communication, February 3, 1995). However, researchers currently are exploring a variety of hypotheses in an attempt to explain how the environment interacts with the individual to bring about manifestations of the disorder. Some theories focus on the notion that individuals with ADHD have an extraordinary need for stimulation (Zental, 1985) or are easily confused with energetic, highly creative people (Cramond, 1994). These hypotheses focus on the behavior-environment relationship: when environmental stimuli decrease, hyperactivity and inattention increase as a means of self-stimulation to compensate for the ‘boring environment.’ Others cite motivational causes for the behaviors (Haenlein & Caul, 1987). These researchers claim the lack of sustained attention owes to the individual’s need for excessive reinforcement both in kind and frequency. They claim that when a task does not have strong intrinsic appeal, it cannot hold the ADHD learner’s attention. Some argue that children with ADHD show poor self-regulation of behavior, thus failing to meet the demands expected in certain situations (Routh, 1978). Usually these situations are highly structured and require adherence to a specific set of social rules (Barkley, 1990).
The important issue is that, although each of these hypotheses has implications for intervention, they cannot be considered in the absence of theories explaining the unique qualities of gifted students and how those characteristics modify conceptions of ADHD in the gifted population. Unfortunately, the majority of researchers and professionals involved in the area of ADHD have little contact with experts in the social and emotional development of the gifted child. Likewise, few theorists or practitioners in gifted education are familiar with the literature of medicine, psychiatry, or special education. This lack of paradigm sharing limits the ability of concerned professionals to offer complete and appropriate diagnoses or effective strategies for addressing the problems of gifted youngsters with ADHD.
ALTERNATIVE PERSPECTIVES
According to Gordon (1990), far too many gifted students are referred for problems with hyperactivity and attention. There are several important perspectives rarely discussed in the ADHD literature that may help to explain why some gifted youngsters have difficulty in adapting to traditional schooling and may, therefore, be especially susceptible to attention problems. A variety of new research findings, research-based theories, or applications of old theories to the gifted population present opportunities for better understanding ADHD and its relationship to gifted youngsters. These include the emotional development of gifted students, curricular and pacing issues, the nature of intelligence, and adult response to child precocity.
Emotional development of gifted students
The evolving theory of emotional development and developmental potential of gifted individuals (e.g., Dabrowski & Piechowski, 1977; Piechowski & Colangelo, 1984; Olenchak, 1994; Piechowski, 1991; Silverman, 1993) offers a different lens for examining the growing occurrence of hyperactivity and attention problems in gifted youngsters. Dabrowski’s theory of positive disintegration aims to explain qualitative differences of human development. He proposed that gifted individuals had ‘increased psychic excitabilities’ that predicted extraordinary achievement (Nelson, 1989). The concept of overexcitabilities has been described as an expanded and intensified manner of experiencing in the psychomotor, sensual, intellectual, imaginational, and emotional areas. As personal traits, overexcitabilities are often not valued socially and may be viewed as nervousness, hyperactivity, neurotic temperament, excessive emotionality and emotional intensity that most people find uncomfortable at close range (Piechowski & Colangelo, 1984).
Relevant to this discussion is Piechowski and Colangelo’s description of psychomotor overexcitability. They defined the trait as an organic excess of energy or excitability of the neuromuscular system. It may manifest itself as a love of movement for its own sake, rapid speech, pursuit of intense physical activities, impulsiveness, restlessness, pressure for action, drivenness, the capacity for being active and energetic (Piechowski & Colangelo, 1984).
Examples from gifted adolescents describe psychomotor overexcitability needs: when bored they get sudden urges and lots of energy and may ‘goof off’ in school; after long homework sessions they may need to shoot baskets or ride a bike. This energy seems to come as much from boredom as from excitement of new ideas. Some students report the need to dance to music before sitting down to write about a new idea or before mastering a complex musical piece. Cruickshank came to assess hyperactivity and extreme sensitivity to the environment as positive characteristics in bright children rather than as problematic behavior. When such gifted children appear impulsive, it simply may be their extra urge to explore their world (Piechowski, 1991). Their curiosity and desire for knowledge can take precedence over the school’s need for a prescribed curriculum locked in time, sequence, and space. In this sense, the regular classroom can be too restrictive for students predisposed to ‘overexcitabilities.’
Inappropriate curriculum and pacing
Another set of factors that may contribute to school-related problems among gifted students involves curricula and instruction. Problems with hyperactivity, attention, and impulsivity increase when the curriculum is perceived as routine and dull; consequently, certain gifted children are placed at risk for failure. Research has shown that many bright students are not being taught at their instructional level and, by definition, do not require the usual amount of repetition to master many skills (Gallagher, 1990; Reis et al., 1993; Stanley, 1978).
Results of a major national study revealed that much of the regular curriculum is redundant for gifted students (Reis et al., 1993). When as much as 60% of the curriculum was eliminated, gifted students exceeded or equaled achievement levels of matched students who were required to complete the regular curriculum. Consider the plight of those predisposed to seeking greater stimulation: they are at odds with school expectations to be neat, docile, quiet for extended periods, and interested in the teacher’s material.
Chris, mentioned earlier, was often punished for blurting out answers during whole-class lessons. When the teacher asked the class to figure out the answer to a problem, Chris jumped out of his seat, ran to the board, and solved the problem before anyone else had a chance to respond. His teacher cited this instance as extreme impulsivity; her lack of understanding of Chris’ needs produced a misinterpretation of his behavior. Gifted children who are active are placed in double jeopardy: they have an intrinsic need to discover, understand, and master the curriculum, yet when tasks are frustrating or meaningless they may seek arousal elsewhere, often through daydreams, visiting the school nurse, or disrupting class (Baum, 1985; Lind & Olenchak, 1995).
Application of Multiple Intelligence Theory
Gardner’s Theory of Multiple Intelligences (1983, 1993) offers another hypothesis for understanding attention disorders. Denying a unitary conception of intelligence, Gardner claimed that students’ strengths may be in one or more of eight domains: verbal, logical-mathematical, spatial, kinesthetic, musical, naturalistic, interpersonal, and intrapersonal. Because school emphasizes verbal and logical-mathematical abilities, other ways of knowing are restricted and often devalued. Many gifted youngsters who are not achieving in school have exceptional spatial abilities (Baum et al., 1991; Dixon, 1983; Olenchak, 1995; Silverman, 1989).
Often these students are described by teachers as disruptive and off-task. However, when creating with Lego™ bricks, repairing a motor, or drawing, these same students can be calm, focused, and persistent. When hyperactive students are encouraged to learn and communicate in areas of strength (often non-verbal intelligences), even boring tasks are accomplished without behavioral problems. Some students with severe attention disorders who had talent in dance or music attended classes where they were remarkably able to focus and complete tasks (Baum, Owen, & Oreck, 1996).
Adults’ response to child precocity
Some adults (teachers and parents) may be intimidated or overwhelmed by child precocity and may fail to exercise appropriate control, thereby excusing or reinforcing misbehavior and underestimating the child’s ability to self-regulate (Rimm, 1994).
TESTING THE HYPOTHESES: UNDERSTANDING THE ISSUES
There are probably multiple factors contributing to difficulties some gifted students experience. Barkley (1995) suggested a theory emphasizing interaction between student characteristics and environmental requirements. He argues that ADHD is best understood in terms of inhibition, which lies along a continuum from extreme inhibition to no inhibition. Deficits of attention are a special case of low inhibition. Although traits may be enduring dispositions, behaviors can appear or disappear depending on conditions. Creative, high-energy people may take more risks driven by curiosity and stimulation needs. When the environment is too restrictive, such students may be pushed toward extremes resembling neurological ADHD and might require medical, cognitive, or psychological intervention.
Thus, to make an appropriate referral for ADHD behaviors, it is important to consider environmental effects on behavior and estimate to what extent traditional school environments and curricula serve as gateways for attention deficit-like behaviors.
To rule out alternate hypotheses, analyze and modify the environment. If classroom changes — including curricula and instruction — improve attention and behavior, more intrusive interventions can be avoided. We suggest the following strategies to assist in evaluation:
1. Observe and document under which circumstances the child has difficulty attending to tasks and otherwise performs acceptably.
2. Consider Gardner’s multiple intelligences; are there curricular adaptations (e.g., visual or kinesthetic instead of verbal) that might capture the student’s attention?
3. Observe the student’s behavior in different learning environments to estimate optimal learning conditions.
4. Observe parent-child and teacher-child interactions to ascertain whether limits are set, if strategies for self-regulation are provided, and whether the student is able to self-regulate.
5. Observe the child at different times of day to decide to what degree creativity is appreciated, reinforced, or allowed expression.
6. Investigate whether efforts exist to develop the student’s gifts or talents and how the student behaves during talent development activities.
7. Pretest the student to assess instructional levels and evaluate appropriate curricular pacing.
The results of these observations can suggest specific strategies to minimize learning obstacles and help discern which students will profit solely from environmental intervention, which will require chemical intervention, and which will need both types of interventions.
Unfortunately, remedies for many bright students with ADHD-like behaviors typically emphasize medication and behavior modification, with little attention to curricula and instruction. Many strategies used in gifted education, such as talent development and differentiated instruction, have been found to accommodate these children in a more positive and appropriate manner (Baum et al., 1996; Baum, Renzulli, & Hébert, 1994; Neu & Baum, 1995; Olenchak, 1994, 1995). Modifications in curriculum, pacing, and instructional strategies had positive effects on attention, self-regulation, and achievement. Offering high levels of challenge and problem-solving opportunities, especially in students’ areas of talent and interest, often led to sustained engagement and no ADHD symptoms.
Consider Bryan, an eighth grader described by teachers as a serious behavior problem who, when allowed to pursue multiple projects aligned with his interests, improved his grades, behavior, and motivation. Appropriate management, project structuring, and access to resources enabled him to complete work and develop goals.
Again the questions: Are observed ADHD behaviors primarily neurological, do they dissipate with tailored educational programs, or do effective interventions require both chemical and environmental change?
TOWARD ANSWERS
As school disabilities attributed to attention deficits soar, many bright youngsters claimed to suffer from ADHD may be misdiagnosed. Treating giftedness as if it were an attention problem, or failing to nurture gifts, may produce greater academic, social, and emotional harm. Educational practitioners and diagnosticians should consider alternate hypotheses before developing treatment plans. Diagnoses can be unreliable; interventions should be guided by a child’s actual needs and consider the broadest array of options to avoid discouraging strengths and ignoring individuality.
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