Could Your Intense Gifted Underachiever Have Undiagnosed ADHD?

This article is adapted from an article I previously wrote for 2eNews.com

 

Some gifted students are clearly bright but don’t do well in school.

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In my experience, a number of these underachieving gifted students are also highly sensitive or emotionally intense.  How can intensity or sensitivity affect academic performance?  Some gifted kids are easily flustered by challenging academic tasks.  Others refuse to do work that seems pointless to them.  Some throw tantrums about homework or rip up their work when they make a mistake.  Some avoid schoolwork because they find it emotionally overwhelming.

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What prevents these bright children from performing in line with their apparent potential?  Could these students be twice-exceptional but undiagnosed, because their intelligence masks their difficulties?  Could undiagnosed ADHD symptoms play a role?

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Very little research has looked at whether underachieving gifted students have an undiagnosed disability or twice-exceptionality that’s making school hard for them or eroding their academic motivation.  In a 2020 study in Gifted Child Quarterly, “Pay attention to inattention: Exploring ADHD symptoms in a sample of gifted underachieving students,” authors Betsy McCoach, Del Siegle, and Lisa DaVia Rubenstein sought to better understand whether some gifted students who don’t earn high grades have undiagnosed difficulties with attention.

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If your intense or sensitive gifted kid doesn’t do well at school, it can be extremely helpful to get to the root cause of their underachievement. If your child is unmotivated or earning lower grades because they process information differently or manage their attention differently, there might be accommodations and interventions that would help them enjoy school more, feel less stressed, and even earn higher grades.

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Here’s who participated in the study:  The researchers recruited teachers from 85 different schools who helped identify gifted students in grades 5 through 12 who were underachieving in reading/language arts and/or math.  For this study, gifted students qualified as underachieving if they performed in the bottom half of their class or had a C average or below. Students who received special education services or who were identified with learning disabilities were not eligible for the study because the authors were interested in the role of undiagnosed attention difficulties.

 

Here’s how the study was conducted:  Students’ teachers and parents completed ratings of ADHD symptoms for each student. The students themselves answered questions about their goal valuation, self-regulation, and self-efficacy.  Goal valuation is students’ belief that doing well in school is important; self-regulation is their ability to set and pursue goals and monitor their own progress towards those goals; and self-efficacy is their belief they can accomplish a task.  Students with stronger goal valuation, self-regulation, and self-efficacy typically perform better in school.  Students’ schools provided course grades.

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Here’s what the authors found:  Among the 212 underachieving gifted students who participated, well over half (62%) met criteria for clinically significant attention issues at home, at school, or in both settings.  Underachieving gifted students primarily had symptoms of inattention, not hyperactivity.  The authors hypothesized that gifted students with hyperactive and impulsive symptoms were probably more likely to have been diagnosed already with ADHD.

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Approximately 19% of the underachieving gifted students in the study—almost 1 in 5 students—had elevated inattention scores at both home and school. This rate far exceeds the typical rate of inattention in the school population.  As the authors noted, these students are the ones most likely to meet criteria for a diagnosis of ADHD should they be referred for a medical diagnosis or neuropsychological evaluation, because a diagnosis of ADHD requires that symptoms be present across multiple settings, such as home and school.  If a student has attention difficulties in only one setting, their symptoms may be due to boredom, anxiety, or other situational factors and not due to neurologically-based differences in attention regulation.

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Among the underachieving gifted students in this study, those with inattention symptoms had different patterns of motivation and performance.  Students whose parents reported high inattention symptoms at home reported poorer self-regulation and lower academic self-efficacy than underachieving students without elevated inattention scores from parents.  They were also less likely to believe doing well in school is important.

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Underachieving gifted students with elevated inattention scores at school or at home also tended to earn lower grades, even though their IQ scores and time spent on homework were equal to those of the underachieving students without significant inattention.

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What’s the takeaway from this research?  Overall, these results suggest that many gifted students who underachieve could in fact have undiagnosed ADHD, inattentive type. 

 

The authors recommended the following for parents and teachers:

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• Pay attention to inattention. As the title of the research article emphasizes, it’s critical that teachers and parents pay attention to inattention symptoms, particularly when gifted students underachieve. The underachieving gifted students in this study had low rates of hyperactive behaviors but high rates of inattention. Inattentive behaviors such as careless mistakes, lost materials, and difficulty remembering directions are often less disruptive than hyperactivity and impulsivity. Parents and teachers may not notice these symptoms or may not find them particularly worrisome. The results from this study, though, suggest that inattention symptoms have important implications for students’ achievement, motivation, and self-perceptions. See the list at the end of this article to learn more about inattention symptoms associated with ADHD.

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• Refer underachieving gifted students for ADHD screening and testing more often. As the study authors noted, “school personnel and parents should consider screening for ADHD more frequently when gifted students underachieve in school, especially when parents report inattentive behavior in the home.” Information from a screening or thorough ADHD assessment may be necessary to help educators and families choose an appropriate intervention, because effective interventions vary based on students’ diagnoses.

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• Match interventions to students’ needs. Not all underachieving gifted students with inattention symptoms have ADHD. In this study, teachers reported significant inattention in almost 50% of underachieving gifted students, but just under 30% of parents reported significant inattention symptoms at home. Underachieving gifted students who are inattentive at school but not at home likely need changes to the school environment, such as more challenging or high-interest curriculum. The authors emphasized that for underachieving gifted students with true attention deficits at home and school, “interventions…should target attentional issues as well as curricular issues” and may include medication or specific learning or organizational strategies to manage symptoms of ADHD.

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The authors of the study also noted that gifted professionals should receive specialized training to help identify gifted students who may qualify for a diagnosis of ADHD and who may be underachieving because of their struggles with attention.

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Unfortunately, teachers and parents may not be aware of common inattention symptoms associated with ADHD and may attribute these symptoms to other characteristics or willful behavior.  In my experience as a therapist, assessment provider, and parent coach, it’s common for adults to misinterpret symptoms of inattentive ADHD as laziness, willful carelessness, low motivation, manipulation, or lying.  Such misunderstandings can cause significant stress or shame for the undiagnosed child and for their parents and teachers, who often care about the child and dislike their own frustration with the child’s behaviors.

 

I’ve talked to countless parents who are uncomfortable viewing their child as lazy, irresponsible, a liar, or unmotivated, but who are not sure how else to understand their child’s behavior.

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These parents often cringe or acknowledge something like, “I hate to say this, but…I worry my child is just unwilling to put in the work.” I think parents often have a gut sense that their child is not lazy or irresponsible, but they don’t know what else could be going on.

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Sometimes, finding out their child has inattentive ADHD gives these parents a clearer and more compassionate framework for understanding their child’s behaviors, challenges, and needs.

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In my work with gifted and 2e families, I have seen that many kids with inattentive ADHD struggle with emotional control and are seen as highly sensitive, emotionally intense, and overwhelmed by transitions as well as new or unexpected situations.  In many cases, kids’ difficulties regulating their attention are at the root of emotional intensity and challenges at school.

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To reduce shame and confusion for these kids and for the caregivers and educators who care about them, more education is needed to inform teachers and parents about common inattention symptoms and appropriate interventions.

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So, what are some examples of inattention symptoms that may be related to ADHD?  The study summarized above (Pay Attention to Inattention) used a rating scale based on the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV-TR), but the symptoms are similar to those in the current edition, the DSM-5. 

 

According to the DSM-5, symptoms associated with ADHD, inattentive type include:

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

• Often has trouble holding attention on tasks or play activities.

• Often does not seem to listen when spoken to directly.

• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

• Often has trouble organizing tasks and activities.

• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

• Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

• Is often easily distracted

• Is often forgetful in daily activities.

 

The popular portrayal of ADHD is that people with ADHD have a deficit of attention or lack attention.  This stereotype can hide a lot of gifted kids' difficulties with attention.  It's not that people with ADHD can't pay attention - instead, people with ADHD have difficulty regulating their attention.  They have a hard time controlling what they pay attention to and for how long.  They also have a difficult time regulating other aspects of their behavior, thoughts, and feelings.

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In gifted kids, ADHD sometimes manifests in a more subtle way.  Because strong verbal or reasoning abilities can inadvertently disguise or distract from attention difficulties, parents and teachers may have no idea that a gifted child struggles to regulate their attention.

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Instead of noticing inattention per se, parents may notice that gifted children and adolescents with ADHD:

• Can focus for long periods of time on tasks they enjoy or find interesting

• Get fully absorbed in activities that do interest them - anything from Minecraft to Legos to math to reading

• Refuse to do, avoid, or fail to complete boring or repetitive assignments

• Need multiple reminders to complete simple daily tasks like brushing their teeth, getting ready for school or bed, remembering their belongings, and picking up their belongings

• Get extremely absorbed in their interests and passions - they might not hear their name called or might get angry when made to stop what they’re doing

• Avoid tasks they dislike or that are uncomfortable

• Rush through work or do the bare minimum instead of putting in sustained effort

• Forget to do things a same-age peer usually remembers

• Need a lot more hands-on help to get things done, such as during the morning or bedtime routine

• Have a messy room, backpack, or play area, and can’t seem to clean it effectively or without a lot of adult help

• Lose track of time

• Sometimes can’t get started on tasks or forget to finish things

• Do things in a way that seems inefficient or disorderly

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To be clear - not all gifted kids with inattentive ADHD perform lower than expected in school. Many excel in school and earn high grades, though often work extra hard or extra long to do so. This research study just showed that among gifted students who earn lower-than-expected grades, many have significant inattention symptoms.

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If you recognize your own intense or sensitive gifted kid in some of these criteria or descriptions, consider pursuing additional screening or testing for ADHD with the child’s pediatrician or with a psychologist or neuropsychologist.