Giftedness, Misdiagnosis, and National Children’s Mental Health Week
By Marianne Kuzujanakis M.D. M.P.H.
“…I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism . I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug…”
~ Modern version – Hippocratic Oath (1964)
In 2004, the National Federation of Families for Children’s Mental Health began a public children’s initiative to occur on the first full week of May each year. National Children’s Mental Health Awareness Week is Sunday, May 3rd through Saturday May 9th, 2015.
One in five children and adolescents have lives complicated by mental health and learning challenges. Early identification and proper support is essential to help children thrive in a complex world. Suicide is the third leading cause of death in adolescents after accidents and homicides. Victims of bullying, and children with sensitivities and personal challenges, can be depressed and engage in self-harm. Statistics indicate that over half of high school dropouts have some type of mental health concern. Thus, many kids enter adulthood with unmet mental health needs.
Gifted children, with “different minds” and intense sensitivities, can be similarly affected. Mental health encompasses (or should encompass) the whole child including one’s social, emotional, intellectual, and spiritual needs. Mental health is comparable to physical wellness and quality of life. Unmet intellectual and/or mental health needs can complicate a gifted child’s life, leading to depression, anxiety, and a variety of other mental and physical health conditions.
The current DSM-IV, and planned 2013 DSM-V, both provide guidelines for physicians to diagnose and treat patients with suspected mental health conditions. This blog series has thus far explored two diagnoses (autism, ADHD) where the guidelines do not always serve the good of all patients. We examined how misdiagnoses can occur, both under-diagnosis and over-diagnosis.
Physicians do not typically receive giftedness education, and thus they are at a disadvantage to recognize giftedness in their practices. Mental health training is also a weakness within primary care medicine. This week, the American Psychological Association met in Philadelphia to discuss the DSM-V, and found that the statistical reliability of a number of diagnoses were far lower than they anticipated, making the accuracy of the proposed DSM-V even poorer than the DSM-IV. Concerns are now rising  whether release of the DSM-V should be withheld. Already, the DSM-V panel is considering making some changes to the proposed guidelines.
Meanwhile, hopeful news is coming from the Academy of Pediatrics (AAP). This month they released a policy statement addressing the negative effects of early childhood adversity and toxic stress, and the need to produce a fundamental change in supporting development, learning abilities, behavior and resilience. Within the policy, I was overjoyed at the additional mention that shortly another AAP policy statement will be released addressing childhood social-emotional needs and specific recommendations for physicians in screening these needs.
Parents of gifted children understand the importance of supporting the social and emotional needs of their children. Sometimes the intensities and asynchronous development of gifted children can be misunderstood as autism, ADHD, conduct disorder, OCD (obsessive-compulsive disorder), ODD (oppositional-defiant disorder), bipolar disorder, and more. Other times, a gifted child may over-compensate for true mental health or learning disorders in such as way that conditions like ADHD, depression, dyslexia, and others are entirely overlooked. Having the AAP actively recognize the connection of social and emotional needs to mental health wellness is a strong step forward for all children.
The gifted world continues its own ongoing work. In 2011 the NAGC Gifted Terminology Task Force released a new position paper on giftedness. This position paper, which attempts to more clearly define giftedness, is by its nature layered with complexity. The gifted world as a whole must continue to make assurances that any definition of giftedness must always embrace the social-emotional message of support, as well as awareness of twice-exceptionality and underachievement and co-morbid mental health disorders. Giftedness should never be “what a child does”, but instead “who a child is”.
The term “giftedness” is wrought in its own difficulties. Many people avoid the term. Clarifying giftedness is necessary to increase acceptance, reduce stressors and avoid misunderstandings that gifted children and adults live with each day. The topic of giftedness needs to be an active contribution to conversations of health, as in many cases “it is” the conversation. Silence on giftedness serves no one, yet silence is a powerful message unknowingly shared with gifted children. Giftedness, when left unspoken, is sometimes perceived by children as a thing of shame or embarrassment, rather than a way of being. Strengths to be cherished are now weaknesses to be hidden away or used inappropriately.
The same can be said of mental health issues. Hiding all these issues away or silencing society to the needs of people with mental health issues produces shame in just the individuals who need help the most. As a society, we need to address the full social, emotional, intellectual, and spiritual needs of all people, young and old, with mental health issues. Giftedness should afford the same support.
During National Children’s Mental Health Week, the focus is on child mental health. The term “health” is not accidental. Let’s therefore support not just illness, but also the health and strengths of the child. The whole child. Strengths and weaknesses are sometimes simply two sides of a coin. Parents of gifted children recognize this too well. Edweek published an article  that emphasizes the need to look holistically at the needs of children, in particular twice-exceptional children in whom giftedness is often overlooked. A determined focus on both health and wellness by physicians, teachers, and parents that includes the complexities of giftedness can be an opportunity for society to do far more for all children.
Be sure to catch the previous posts in this series:
- Part 1: “ADHD, Autism, and Giftedness: An Invitation To A Conversation“
- Part 2: “Autism, Giftedness – and Human Diversity“
- Part 3: “Giftedness, ADHD, and the Complexities of Society“
- SENG Video: The Misdiagnosis of Gifted Children
- University of Wisconsin Grand Rounds presentation by James T. Webb Ph.D.: “Accurate Assessment? Asperger’s Disorder, and Other Common Misdiagnoses and Dual Diagnoses of Gifted Children”
- “Health Care Providers Know Little about Gifted Children” by Goerss, J., Clouse, R., & Webb, J. T. (2008). National Psychologist. 16(2),12.
- “Where does a pediatric doctor fit in the care of gifted children?” by Kuzujanakis, M. (2011). SENGVine, October 2011.
- “Discovering Gifted Children in Pediatric Practice,” by Liu, Y.H, & Lien, J. (2005). Journal of Developmental and Behavioral Pediatrics. 26, 366-369.
- “Gifted and Talented Children: Issues for Pediatricians,” by Robinson, N. M., & Olszewski-Kubilius, P. M. (1996). Pediatrics in Review, 17(12), 427-434.
Marianne Kuzujanakis M.D. M.P.H. is a pediatrician and former director on the board of SENG (Supporting Emotional Needs of the Gifted).