Today’s blog post features Dr. James Webb’s responses to a few questions posed in the Misdiagnosis group discussion on Linkedin.
There are many unanswered questions surrounding misdiagnosis in gifted children and adults.
Dr. James Webb has initiated the Misdiagnosis and Dual Diagnoses for Gifted Children and Adults group on LinkedIn to encourage those with questions and those knowledgeable about the topic to interact and help the gifted community to better understand how to identify and prevent misdiagnosis of gifted children. Supporting the Emotional Needs of the Gifted (SENG) showing their support by introducing the SENG Misdiagnosis Initiative.
To get involved with the conversation and have your questions answered,
follow this link: http://lnkd.in/pPibSf
Or search for the Misdiagnosis and Dual Diagnoses for Gifted Children and Adults group on LinkedIn. The following is just a small section of the on-going conversation:
- Is there any research showing the percentage of misdiagnosis among the gifted?
Dr. James Webb (JW): We do not yet know the percentage of misdiagnosis among gifted children or adults. We would like to do such research, but getting funding for it is very difficult. At this time, we simply have numerous case studies, which fortunately are a time-honored tradition in health care when one is looking at a new clinical area.
- Is it possible that also among other patients we will see a similar amount of misdiagnosis? Any research known? And what about misdiagnosis in the whole of the medical domain (including non-psychic disturbances)?
JW: I do not know the frequency of misdiagnoses made by physicians and psychologists in other areas. I will see if I can find this, since it would provide important base rate data.
- Is the effect indeed often disastrous for a patient, or more often for the status of psychiatry in the eyes of the informed public?
JW: The effect is much more on the patient than on the field of psychiatry. Because psychiatrists and psychologists do not know what they do not know, they come up with rationalizations for why they were correct in their diagnoses. This is made worse because the field of psychiatry has come to rely so heavily on psychopharmacological treatments, and far less on understanding the patient and the situation.
- Is the effect of a diagnosis, of the way of questioning, of asking for complaints and for the impairment of some neutral behavior: a distortion of a healthy mindset, and causing a bias called “the positive test bias” (We say more often yes to questions…without having a stable criterion.)
JW: I am not sure I understand what you are asking, but I will answer what I think is the question, which ties in with your [next] question.
- It possible that the gifted have a rather limited self-knowledge, and while he answers the questions of the psychiatrist, will construct a distorted view of himself. This effect is called framing, and a long list (50?) of cognitive biases can be seen as causing this. (Maybe unknown in psychiatry?)
JW: Gifted children and gifted adults often lack self-understanding to a great degree. They have a sense that they are different than others because others often tell them things like, “You think too much; you are too sensitive; too strong-willed, too intense, too self-absorbed, have a strange sense of humor, etc.” Because of this, gifted children and adults may be more likely to accept a diagnosis that something is wrong with them. However, having said this, there is a different scenario with many gifted children if they are not treated with intellectual respect by the psychiatrist or psychologist. In that situation, the child is likely to become obstinate, superficial, or even may intentionally try to play a game where he tries to see how much he can deceive the psychiatrist or psychologist.
- Is any psychiatric diagnosis causing more collateral damage than help, because of the implicit suggestion of a lifelong, inborn, incurable disease; so the patient may think he will have a limited responsibility for his behavior: it may create the feeling of helplessness for problems that are just part of any life?
JW: Many psychiatric diagnoses can cause collateral damage where the patient now feels unable to control his or her behavior. Parents, too, will sometimes use the diagnosis as an excuse and say, “Well, after all, he can’t control himself because he has ADHD, OCD, ODD, etc.” and the parents or teachers absolve themselves of responsibility to help the child learn to manage himself and his behaviors. What we are finding in the United States is that pediatricians and family practice doctors are particularly open to engaging in “anticipatory guidance” with families, including families of gifted children. This is very helpful since over 75% of psychotropic medications are prescribed by non-psychiatric physicians, and these physicians are the ones who are treating most of the children and adults with emotional problems. This is why many of us are trying to provide formal Continuing Education programs for pediatricians, family practice doctors, psychologists, as well as psychiatrists.
- What’s very popular here [in the Netherlands] is the so-called verbal/“performal” discrepancy. Many psychologists think there IS something going on when this occurs during an IQ test (WISC) and do not realize that this does not have to be the case.
JW: I am sorry to hear that the psychologists there still rely so heavily on the difference between Verbal IQ and Performance IQ scores. There is good research (much of it summarized in the Misdiagnosis book) to document the asynchronous development intellectually in gifted children, along with the finding that the higher the overall intellectual level, the more likely the child is to have a difference or span in the sub-test scores (and abilities in different intellectual areas). Of course, also there is the asynchrony where the child’s judgment lags behind intellect, and that also adds to the difficulty when trying to make a diagnosis.
If you are interested in learning more about misdiagnosis in gifted, check out the GPP book Misdiagnosis and Dual Diagnoses of Gifted Children and Adults.