ATTENTION DEFICIT DISORDER AND ATTENTION DEFICIT WITH HYPERACTIVITY DISORDER RESEARCH

Chae, P. K., Kim, J.-H., & Noh, K.-S. (2003). Diagnosis of ADHD Among Gifted
Children in Relation to KEDI-WISC and T.O.V.A. Performance, Gifted Child Quarterly, 47(3), pp. 192-201

• Study was conducted “to evaluate the correlation between intelligence and a Continuous Performance Test (CPT) that assesses ADHD in children.” (p. 192)
• 177 elementary school children were studied—106 gifted from the Educational Institute for Gifted Children and 71 non-gifted from elementary schools in Seoul.
• 73 boys and 33 girls / average age 7.7 years with a range of 6 – 9 years, average IQ 138.4 with a range of 130 – 157 for gifted group and 83 – 127 for non-gifted group. (p. 194)
• About 9.4% of the gifted children were identified with ADHD using the Test of Variables of Attention (T.O.V.A.), Child Behavior Check List (CBCL), and Teacher’s Report Form (TRF).
• “The prevalence of ADHD in children among the clinical population is approximately 40%.”
• “Due to the alarming number of referrals for attention disorders among gifted children, there is concern that some nonintellectual features of gifted children (e.g., creativity) may be misinterpreted as symptoms of ADHD.”
• This study suggests that “higher norms on tests such as T.O.V.A. may be necessary for diagnosing ADHD in gifted children.” 
• “Thorough investigation about the nature of inattention, impulsivity, and hyperactivity is necessary for the diagnosis of ADHD among gifted children.”
• “Medication is usually successful in controlling behavior, but it is also suspected of inhibiting creativity and intellectual curiosity in bright children.” (p. 193)
• Discussion of overexcitability as opposed to ADHD in gifted children.  “It is difficult to differentiate a gifted child’s overexcitability from ADHD symptoms.”
• “There is perhaps a very large overlap between what we call ADHD and creativity.”
• “Those with IQs over 130 are hardly ever diagnosed with ADD.”
• “Children with ADHD perform comparatively poorly on tests in general.”
• “Gifted children tend to demonstrate weakness in one or two subtests of the Freedom From Distractibility Factor of the KEDI-WISC (a Korean version of the WISC), such as the Arithmetic and Digit Span subtests.” (p. 194)
• T.O.V.A.’s visual mode was used for this study – small black squares appearing on a computer screen.
• The CBCL and TRF are observational instruments recorded on scales with no references as to WHY the behaviors are occurring.  
• Data was analyzed in a number of ways and a discussion of this analysis is provided. (pp. 195-199)
• “Thorough investigation about the nature of inattention, impulsivity, and hyperactivity is necessary for the diagnosis of ADHD among gifted children.” (p. 200)
• “Gifted children with ADHD can likely benefit from social skills training to improve relationships with their peer group.” 
• “Generalizing these findings to other situations and cultures requires caution because the subjects were not recruited from general schools but from an institute for gifted children." 
  

Leroux, J. A. & Levitt-Perlman, M. (2000). The Gifted Child with Attention Deficit
Disorder: An Identification and Intervention Challenge, Roeper Review, 22(3), pp. 171-176)

• Study “reviews the literature on ADHD traits, their similarity to gifted and creative behaviors, and the implications for educational interventions.  A case study of a [third grade] boy identified with ADHD provides the focus” for the discussion. (p. 171)
• Child in study has always been at least two years ahead of his peers academically, but is immature.  His teachers have not considered the possibility that he might be gifted.
• “The diagnosis of DHD does not include any intellectual boundaries and the characteristics of it are remarkably similar to those of creativity.” (p. 172)
• Characteristics associated with both ADHD and giftedness include: hyperactivity, challenge of authority, disruptive behavior, and social/emotional development in asynchrony with intellectual development.
• “Multiple diagnostic measures which would reveal gifts, attentional problems, learning disabilities, and emotional problems, are necessary.” (p. 173)
• “Results from the WISC III-R may not be accurate in many children with ADHD whose lack of attention to the tasks may affect scores.  Their high levels of creativity may go undetected.  The WISC III-R Freedom From Distractibility Factor is not always considered a reliable indicator of ADHD.  When school boards require identification before beginning enrichment programs, gifted/ADHD students fall through the assessment cracks.”
• Sad story:  “Though Jason displayed many of the characteristics of ADHD, his kindergarten teacher told his concerned parents that it was not possible because Jason was too smart.  As he continued through grades 1 and 2, teachers focused on behavioral problems rather than his advanced academic achievement.  In fact, on his grade 1 report card, his teacher failed to mention that he was reading at grade 4 level.  They never suggested testing for ADHD because they could see that he was able to focus when he so chose.  Now, grade 3, Jason has lost interest in school due to the frustration of unchallenging activities and peer rejection.  His self-esteem is low and he is performing at grade level, though group achievement tests have p[laced him significantly above average.  Now Jason’s teachers see no reason to consider giftedness or ADHD; they just look at him as a difficult child with an attitude problem.”
• “Olenchak reported that a highly structured individualized school wide enrichment program (based on Renzulli’s model) was found to have a positive impact on the attitudes, self-concepts, and relative productivity of gifted/LD students. … It would be especially beneficial for gifted/ADHD students, giving them the opportunity to focus their energy on challenging and meaningful tasks.” (p. 174)
• “Pirie (1995) pays special attention to the process of learning.  By teaching English through kinesthetics, he uses the area in which students are skilled to approach another subject.  A musical child, for example, might react more positively to the prospect of writing a song about the environment than to the idea of writing an essay on the topic.”
• Extrinsic motivation can be beneficial with gifted/ADHD children.  For example, “If you get your work done now, we will have time to go get your skates sharpened.”
• A wonderful chart listing behavioral, curriculum, and instructional strategies for the gifted, ADHD, and gifted/ADHD child is provided. (p. 175)

Lovecky, D. V. (1999). Gifted Children With AD/HD, Paper presented in slightly
different form at the Annual CHADD International Conference.

• Four major conclusions: (1) Gifted children with AD/HD differ from average children with AD/HD in cognitive, social, and emotional variables; (2) They miss many easier items and are correct on much more difficult items on tests of intelligence and achievement; (3) Their abstract reasoning ability is often well developed and in advance of other more basic skill levels, and; (4) They exhibit more mature use of metacognitive strategies but often forget to use them, accounting for variability of work product.
• Can become overwhelmed with worries
• Empathetic and compassionate for others
• Advanced need for complexity in friendships, but often misread social cues and show lack of understanding of group goals
• Gifted children with AD/HD differ from other gifted children
• Show a greater degree of asynchrony among cognitive, social and emotional areas of development, and much greater variation in ability to act maturely
• Cognitive deficits are shown in less ability to think sequentially, to use working memory adequately.
• Complete less work, tend to hurry through it, often change topics on projects, take inordinately long to complete simple exercises
• Find it difficult to work in groups, even groups of gifted children
• Intrinsic reward of completion is not as satisfying
• When working on self-chosen activity, is able to work for long hours without much external reinforcement – even with AD/HD
• Show more difficulty with self-control and self-monitoring behavior
• Assessment of gifted children needs to be done by those knowledgeable about both giftedness and AD/HD
• Gifted children with mild AD/HD who are placed in a stimulating school environment with small classes will see significantly decreased symptoms of AD/HD
• G-AD/HD children should be compared to gifted peers in a stimulating environment rather than to average children in regular classes
• A profile of strengths and weaknesses needs to be collected from home, school, and other activities.  These should then be compared to the child’s own mean, rather than to absolute age norms.  “Deficit areas of gifted children with AD/HD can be overlooked if only age norms are used as a measure of ability or achievement.”  
• “Intelligence should not just be based on the Wechsler scores.  Use of the Stanford-Binet LM as a supplementary test should be considered when two or more verbal subtests of the Wechsler are in the SS 17+ range,” indicating too low a ceiling. 
• Recommendations about Individual Education Program (IEP) or Section 504 planning need to consider both AD/HD problems and the effects of being gifted.
• “Gifted children with AD/HD may need acceleration at the same time that they need to learn metacognitive skills that will support the higher level of functioning required.”
• “They will need a differentiated program, not just placement in an advanced class.”
• “They may need to be specifically taught study and organizational skills, in the context of higher level work, that gifted peers acquire without difficulty.”
• They need access to mentors to work in areas of strength.

Moon, S. M. (2001). “Gifted Children With Attention-Deficit/Hyperactivity Disorder” in the social and emotional development of gifted children: what do we know?  Washington, D.C.: Prufrock Press, pp. 193-201.

• “Little empirical research has examined the unique issues that arise when AD/HD and giftedness co-occur.” (p. 193)
• “In the current edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, four subtypes of AD/HD are recognized:  Predominantly Hyperactive/Impulsive, Predominantly Inattentive, Combined, and Not Otherwise Specified.” (p. 194)
• “Cognitive tests of pre-frontal functioning [in children with AD/HD] show developmental delays of two to three years.”
• “These students have deficiencies in executive functioning that influence their behavior at home and at school.” I thought that executive functioning wasn’t consistent with intelligence until a child matures – up to mid-20s, if ever.
• If a gifted child is misidentified as having AD/HD, it would have “negative consequences for the social and emotional development of a gifted child because his or her real needs would not be met and because he or she might receive inappropriate treatment, such as unnecessary psychotropic medication.” (p. 195)
• “Giftedness can mask an attention-deficit disorder for a time. … The higher the IQ, the later the AD/HD diagnosis tends to occur.”
• “Hidden AD/HD has negative effects on the self-concept of the gifted child because trying harder has little effect on such AD/HD as disorganization, daydreaming, incessant talking, inability to sit still, and social immaturity.”
• “Children with AD/HD typically score 1-10 points lower on IQ tests than normal children at the same ability level.” (p. 196)
• “Children with AD/HD have more difficulty than normal children sustaining attention to low-interest, low-stimulation activities with distal reinforcers.”  This seems more like an attribute of a gifted child who wants to move on to something interesting and active.
• “Children with AD/HD can sustain attention better than normal children when interest is high, tasks are challenging, and reinforcement is rapid.”  Again, this sounds like a gifted child who is fascinated with things that interest him, enjoys being challenged, and sees immediate reinforcement.
• “Gifted children with AD/HD have difficulty regulating their emotions.” (p. 197) How is this different from Dabrowski’s overexcitabilities of gifted children?
• “Children with AD/HD … exhibit annoying and sometimes aggressive behaviors that are disliked by their peers and can lead to social rejection.”  Gifted children pass through parallel play into interactive play at an earlier age and sometimes exhibit aggression in response to their frustration that other children to not understand their “rules.”  This can lead to social rejection that has nothing to do with AD/HD.
• “Gifted children with AD/HD have difficulties sustaining attention to routine tasks, shifting attention, transitioning between tasks, monitoring their progress on long-term projects, keeping track of homework, organizing their desks and lockers, and following directions.” (p. 198)  Gifted children do not like routine tasks, get involved in what they are doing and do not want to move on until they are finished, get sidetracked by interesting branches when working on long-term projects, and often don’t consider homework of something they already know or organization of their desks to be important.
• The gifted child with AD/HD has a preference for “high-stimulation learning contexts.  They like hands-on activities, computer-based instructions, high-interest content, and one-on-one attention from an adult.” (p. 199) 
  

Moon, S. M., Zentall, S. S., Grskovic, J. A., Hall, A., & Stormont, M. (2001).  Emotional and Social Characteristics of Boys With AD/HD and Giftedness: A Comparative Case Study, Journal for the Education of the Gifted, 24(3), pp. 207-247.

• Participants were 3 boys with AD/HD and giftedness and 6 comparison boys with only one of the two exceptionalities – 3 with AD/HD and 3 GT alone.  Data was collected from the boys, their parents, and their teachers. (p. 207)
• “Participants with co-occurring giftedness and AD/HD had difficulties regulating their emotions, problems with peer relationships, and stressed families.  Giftedness appeared to exacerbate the social/emotional difficulties associated with AD/HD rather than serve a protective function.  The findings suggested that AD/HD is a risk factor for psychosocial adjustment difficulties in young boys who are intellectually gifted.” 
• “In general, intellectually gifted children have been found to be as well or better adjusted emotionally than children of average intelligence during the elementary school years. … The social/emotional problems that do exist among gifted children are often exogenous in origin, [such as] inappropriate, unchallenging educational contexts.” (p. 209)
• “The studies that have been conducted suggest that G/LD students experience internal dissynchrony and high levels of frustration.  Such students also have been reported to have problems with their relationships with teachers and peers.  At the same time, there is some evidence that parents perceive GLD children positively, finding them easy going and cooperative with adults.” (p. 210)
• “Little attention has actually been paid to the characteristics and needs of gifted children ho actually have coexisting AD/HD.” (p. 211)
• The first two authors of this study had different theoretical perspectives: Moon specializes in research on GT and Zentall specializes in research on children with AD/HD.   “These differing areas of specialization provided theoretical triangulation in the design and analysis stages of our research.” (p. 212)
• Participants in study were all enrolled in Midwest school district that  “(a) utilized an identification procedure that encouraged the inclusion of students with AD/HD in gifted programming; (b) provided self-contained classes in gifted education with differentiated curricula taught by teachers with certification in gifted education; and (c) served as a statewide model of excellence in programming for gifted students.”  (p. 212)  In other words, students should be placed in appropriate educational environments.
• Data Collection:
  (1) Interviews with children, parents, and teachers
  (2) Rating Scales
  (3) Conners Rating Scale-Revised, Home Situations Questionnaire-Revised, and Family Environment Scale were given to parents
  (4) Teacher form of the Conners Rating Scale-Revised was given to teachers
• Analysis of Data:
  (1) Descriptive quantitative analyses
  (2) Case Analyses
  (3) Within-Group Analyses
  (4) Cross-Group Analyses
• Findings reported in 3 categories:  emotional characteristics, peer relationships, and family process.
• Emotional Characteristics:
  (1) G/ADHD – least mature with poorest emotional adjustment of 3 groups
  (2) ADHD – fair to good maturity and emotional adjustment
  (3) G only – rarely over-responded emotionally to situations and were judged to have good to excellent emotional adjustment  (pp. 221-224)
• Peer Relationships:
  (1) G/ADHD – immature, annoying, and irresponsible behavior, contributed to social rejection in self-contained classrooms for gifted students.  Described as “friendless loners in school who were tolerated by their gifted peers, but seldom picked as work or play partners.” (p. 225)  They did have some friends in out of school contexts, enjoy imaginative play, creating things.  (p. 227)
  (2) ADHD – exhibited many behaviors associated with disorder but with “only minor impact on their social functioning at school.  Although described as hyperactive and annoying, outcasts, silly and immature, an oppositional and aggressive, none of the boys in this group appeared to be rejected by their peers at school.”  They did participate in organized team sports, which may have contributed to their successful social functioning, since sports participation receives high status among young boys.  These boys had friends in their neighborhoods and in school who shared their active play styles and occasionally got into trouble. (pp. 228-229)
  (3) G only – “difficult to characterize the overall social functioning of the three boys in the pure GT group as a group because they were heterogeneous in this area.” (p. 229)
  (4) G-1 was most mature and socially skilled, popular in classroom and in neighborhood, participated in sports as a hobby, a leader, cooperative in class, well-adjusted, empathetic.
  (5) G-2 was tougher, pushy with thoughts and ideas, did have group of friends who “shared his interests in science, space, fantasy, and dramatic play.”  (p. 230)
  (6) G-3 liked sports but was not participating in them, having difficulties with peer relationships, had a single good friend, but teacher attributed his difficulties socially as being “too advanced for the other kids when it comes to just being able to relate and play.”
• Family Process:
  (1) G/ADHD – unstructured and disorganized family processes, difficulty establishing consistent routines, moderate to high levels of conflict between parents and child (except for G-1 whose family style emphasized autonomy and differentiation over closeness and cohesion but did not fight or yell). Families in this group did not do very many things together as a family unit, compared to the other two groups. (pp. 230-233)
  (2) ADHD – less conflicted and hectic than the families of GH-1 and GH-2, “actively working at developing closeness in their families and created many opportunities for family outings and active, shared activities.”  These families valued traditional family sit-down meals, had clear rules, children had chores, routines were reinforced. (pp. 234-235)
  (3) G only – strong interpersonal relationships, well-organized family life, and many shared activities. (p. 235)
• Threats to the validity of the study:
  (1) Small number of participants
  (2) Reliance on self, parent, and teacher reports rather than researcher observations
  (3) Missing data.” (p. 236)
  (4) “Intellectually gifted boys with AD/HD placed in heterogeneous classrooms might exhibit different social/emotional characteristics from those placed in special classes for gifted students.” (p. 236)
  (5)“All the participants were white males between the ages of 8 and 10.”
• “The families undergoing a current relationship transition were more stressed than both stable single-parent and stable biological-parent families.  … Family transitions should be taken into account in future investigations of the characteristics of families of children with giftedness, AD/HD, or both. (p. 238)
  

University of Central Florida (2009, March 11). Hyperactivity Enables Children With ADHD To Stay Alert: Teachers Urged Not To Severely Limit That Activity. ScienceDaily. Retrieved May 24, 2009, from http://www.sciencedaily.com­ /releases/2009/03/090309105038.htm Hyperactivity Enables Children With ADHD To Stay Alert: Teachers Urged Not To Severely Limit That Activity

• A new University of Central Florida study may explain why children with attention deficit hyperactivity disorder move around a lot – it helps them stay alert enough to complete challenging tasks.
• In studies of 8- to 12-year-old boys, Psychology Professor Mark D. Rapport found that children with and without ADHD sat relatively still while watching Star Wars and painting on a computer program.
• All of the children became more active when they were required to remember and manipulate computer-generated letters, numbers and shapes for a short time. Children with ADHD became significantly more active – moving their hands and feet and swiveling in their chairs more – than their typically developing peers during those tasks.
• Rapport's research indicates that children with ADHD need to move more to maintain the required level of alertness while performing tasks that challenge their working memory.
• Performing math problems mentally and remembering multi-step directions are examples of tasks that require working memory, which involves remembering and manipulating information for a short time.
• "We've known for years that children with ADHD are more active than their peers," said Rapport, whose findings are published in the Journal of Abnormal Child Psychology. "What we haven't known is why."
• "They use movement to keep themselves alert," Rapport added. "They have a hard time sitting still unless they're in a highly stimulating environment where they don't need to use much working memory."
• Rapport compared the children's movements during the tests to adults' tendency to fidget and move around in their chairs to stay alert during long meetings.
• The findings have immediate implications for treating children with ADHD. Parents and educators can use a variety of available methods and strategies to minimize working memory failures. Providing written instructions, simplifying multi-step directions, and using poster checklists can help children with ADHD learn without overwhelming their working memories.
• "When they are doing homework, let them fidget, stand up or chew gum," he said. "Unless their behavior is destructive, severely limiting their activity could be counterproductive."
• Rapport's findings may also explain why stimulant medications improve the behavior of most children with ADHD. Those medications improve the physiological arousal of children with ADHD, increasing their alertness. Previous studies have shown that stimulant medications temporarily improve working memory abilities.
• Rapport's research team studied 23 boys, including 12 who were diagnosed with ADHD. Each child took a variety of tests at the UCF Children's Learning Clinic on four consecutive Saturdays. Devices called actigraphs placed on both ankles and the non-dominant hand measured the frequency and intensity of each child's movement 16 times per second. The children were told they were wearing special watches that allowed them to play games.
• In the first of the two published studies, the research team demonstrated that children with ADHD have significantly impaired visual and verbal working memory compared with their typically developing peers. In one test, the children were asked to reorder and recall the locations of dots on a computer screen. Compared with their typically developing peers, the children with ADHD performed much worse on that test – and on a similar one requiring them to reorder and recall sequences of numbers and letters.
• The second study focused on the frequency and intensity of movement by the children while they were taking those two tests.

Zentall, S. S., Moon, S. M., Hall, A. M., & Grskovic, J. A. (2001).  Learning and
Motivational Characteristics of Boys With Ad/HD and/or Giftedness, Exceptional Children, 67(4), pp. 499-519.

• “This study compared the academic and learning characteristics of [9] students with (a) Attention Deficit/Hyperactivity Disorder (AD/HD), (b) giftedness, and (c) giftedness with AD/HD [in a Midwestern school district].” (p. 499)
• G = Gifted only ; GH = Gifted and ADHD; H = ADHD only
• Limitations of study:  small number of participants, missing data, no additional GH comparison group in the general educational context. (p. 512)
• Three different reporting sources were utilized – teachers, parents, and the children in the study. (p. 500)
• “The mean age of the nine participating boys … was 9 years, 2 months (range 8 years 4 months to 10 years 6 months).” (p. 501)
• Study used a multiple-case design.  (p. 502)
• Parents and teachers filled out ratings scales (p. 503)
• Multiple levels of analysis:  case analysis (1-2 hour peer debriefings every 2 weeks for 3 years); within-group, cross-case analyses; cross-group analysis
• “All three groups of students (G, GH, H) at this age had difficulties completing tasks requiring lower level skills, which may be characteristic of young boys in general.” (p. 505)
• Disorganization was reported by multiple sources in the H and GH groups.
• “Students with GH demonstrated creativity through humor, creating games, assembling ideas or things in novel ways, and imaginative expressions.” (p. 506)
• “Problems with Specials (art, gym, music) were reported only for the pure H group.”
• More gifted children than would be expected by chance, who also met the rating criteria for AD/HD, were placed in a highly creative subgroup within a gifted school program.”  (pp. 508-509)
• “In contrast to the reported talents and preferences, there was evidence that high intelligence made some of the problems of students with AD/HD more apparent.”
• “GH students were aware of heir teachers’ displeasure and were able to articulate the discrepancy between expectations and performance.”
• “Overall, there was consensus for all the students in that science was the most preferred, especially when there were experiments or projects.” 
• “The most helpful motivational strategies reported for all three subgroups of students at this age were teachers who gave students individual attention and took personal interest in them.” (p. 510) 
• The G group preferred to work alone, but the GH and H groups preferred group learning and opportunities for discussion.
• Awareness is necessary of the importance of monitoring comprehension rather than the appearance of attention.  (p. 511)
• The strategy of taking away activities when the child does not do work often makes the situation worse, especially for the GH students.  “Withholding activity further reduces stimulation making it harder, not easier, for the child to complete non-meaningful and non-challenging tasks.”  (p. 512)
• “Both groups with AD/HD (H and GH) were generally described as underachievers.” (p. 513)
• A dislike for homework was directly attributable to AD/HD in both gifted and not gifted groups. 
• “The emotional maturity of students with GH does no appear to be at the same level as their intellectual and imaginational talents, which may contribute to social/emotional adjustment difficulties.”  (p. 516)