The Gifted Child

Introduction

We are all familiar with the concept of “the gifted child.” Certain children and adolescents have skills and abilities that far exceed those of most of their peers. Yet, when pressed by parents or schools to diagnose and manage giftedness, we find that working with a gifted child is not simple. As pediatricians, we advise patients and families about a wide range of developmental and behavioral phenomena. When we encounter a gifted child, we need to be aware of the great variety of skills and abilities that constitute giftedness. This developmental variation may affect family function. Further, we need to advise families about helping their exceptional children succeed in their academic and social lives.

Robinson and Olszewski-Kubilius, writing in this journal (Pediatr Rev. 1996;17:427–434), addressed the topic of gifted and talented children. They listed a number of characteristics of these individuals and addressed child and family issues that may arise during each period of a gifted child’s development. The following clinical vignettes demonstrate the highly variable nature of giftedness and highlight important issues that the pediatrician must address to provide optimal management. It must be noted that these cases all depict“ schoolhouse giftedness,” where the linguistic or mathematical-logical domains are greatly advanced. Other children may be gifted in other areas, such as spatial reasoning, music, art, or kinesthetic ability. These children also need special attention and nurture.

Case 1

Adam was 3 years and 4 months old when he presented for his first health supervision visit, which occurred soon after his father accepted a position as a history professor at the local university. Adam’s mother, who had a graduate degree in children’s literature, chose to defer her academic career while raising Adam and his 9-month-old sister Jodie. Findings on the medical history and physical examination were normal. The developmental history also seemed to be unremarkable until the pediatrician asked about Adam’s language development. When the parents proudly replied that Adam was very verbal and knew what “anthropomorphic” meant, the physician asked them if their son really understood the concept. Adam interrupted to say,“ Thomas the Tank Engine is anthropomorphic.”

Adam demonstrates one of the more typical presentations of giftedness. His advanced language and intuitive understanding of concepts are among the more common of the many characteristics of gifted children. His verbal advancement was obvious to the pediatrician, who confirmed Adam’s parents’ belief that their son was special. Adam was fortunate in that his family was interested in education and in developing their son’s strengths, and they had the financial means to provide for him. Other gifted children, such as those in educationally or economically disadvantaged homes, may have no one but their pediatrician to advocate for them with families, schools, and social agencies about their particular needs.

When the parents asked about how best to educate Adam, the pediatrician made several recommendations. He pointed out that in early childhood, the most beneficial step would be to engage in family-centered activities that would enrich Adam’s environment. He encouraged them to continue their custom of reading together, but to read material at a higher level, and he reinforced their habit of taking frequent excursions to interesting places and activities around town. Importantly, he advised against the parents directly teaching Adam academic material unless he actively sought it from them. The pediatrician pointed out that Adam’s social, behavioral, and motor development were consistent with his chronologic age, unlike his advanced intellectual development. This discrepancy meant that Adam was having asynchronous development, a common finding among gifted children, so the parents were advised not to accelerate his entry into formal education. In other circumstances, when a child is closer to the regular age of school entry, and when he or she is developing more synchronously, it might be reasonable to consider earlier entry into school.

The pediatrician provided further anticipatory guidance for the family. He advised that Adam’s complete development would be optimal only if the family’s life did not revolve entirely around his giftedness. Although he supported the parents’ decision to set high expectations for the boy, he recommended that they avoid the pitfall of excusing him from the ordinary behavioral expectations of children just because he was special. In short, he suggested that they set limits on his behavior and expect him to contribute his share to the overall life of the family. He also advised them to remember Jodie’s developmental needs. Whether or not siblings are gifted, excessive attention to the identified child may place other children at some risk for dysfunctional behavior.

Finally, the pediatrician warned the parents about stresses common to many contemporary families, with or without gifted children. The family eventually might face difficult economic decisions concerning special schooling or possibly moving to a more favorable school district and logistic difficulties in managing special lessons, clubs, or events. Although all families face issues of finance, energy, and time management, such considerations may be magnified in families who have gifted children and can damage family relationships if they are not recognized and overcome.

Case 2

Henry, a 7-year-old boy, had been in his pediatrician’s practice since birth. When he was almost 3 years old, he was placed in a child care center, and the staff soon reported that he was “different” from the other children. He was physically very active, had difficulty staying“ on task” with his group, and was extremely sensitive, crying easily when limits were set or when his wishes were frustrated. Still, the staff found him lovable and were impressed by his sense of humor because he would laugh at events they found funny, but which passed over the heads of his peers. His parents asked the pediatrician for advice, and she referred him for a psychological evaluation. At a chronologic age of 36 months, he had a mental age of 60 months and was diagnosed as being gifted.

Now, at age 7 years, second grade was not going well. Although Henry showed excellence in reading and arithmetic, the teacher could not control his activity. He ran around the classroom, failed to complete assignments, fought with classmates, and said he was “bored.” His parents had read extensively about developmental issues in gifted children and reported that all his troublesome behaviors had been described in gifted school children. They asked the doctor for advice about placing Henry in a more challenging academic environment. The pediatrician, after an appropriate assessment, diagnosed attention deficit hyperactivity disorder. She worked with the school to place Henry on an individualized educational plan and prescribed methylphenidate. His academic, behavioral, and social performance improved.

Henry’s case points out the complexity of assessing behavioral concerns in the face of giftedness. At an early age, Henry’s behavior could be explained entirely by giftedness. A high level of physical activity, short attention span, and poor social skills often are seen in gifted children, as is a sophisticated sense of humor. Henry’s parents had come to think of his giftedness as the central fact of his being, and they readily accepted his ongoing idiosyncrasies as manifestations of his exceptional status. Even in the second grade, his behavioral pattern might have been related entirely to his giftedness; high-intensity, high-curiosity behavior is common among such children. Also, Henry might have been displaying asynchronous development, with his social and motor domains lagging behind his intellect. However, gifted children are no more immune from other developmental or behavioral concerns than are their classmates. The presence of giftedness does not preclude a child from having attention deficit hyperactivity disorder, as Henry demonstrated.

It is easy to see how Henry’s parents could become so focused on his giftedness. Each successive school year requires progressively greater parental involvement in educational issues. Parents appropriately become involved in school matters such as proper classroom setting, grade acceleration, and specially designed teaching programs for their child’s needs. They may be highly involved with enrichment activities in the school as well as with special classes, contests, and events in the evenings, on weekends, and during holidays. The burdens of time, money, and energy increase during the school years and may divert parental attention from other developmental concerns. The pediatrician needs to evaluate how the family is coping with these issues and should provide or recommend counseling, if necessary.

Case 3

Emily was a 14-year old girl who always had done very well academically, which her parents expected of all three of their daughters. Now a freshman in high school, Emily developed anorexia nervosa, and failure of outpatient psychotherapy led to an inpatient admission. Psychometric evaluation at that time revealed that Emily had an intelligence quotient (IQ) of 140, but had a significant learning disability in mathematical reasoning. She was barely able to do eighth-grade mathematics, unlike her older sisters, both of whom were in advanced placement mathematics classes in the same high school. Psychotherapy revealed that one of Emily’s major concerns and frustrations was that she “wasn’t as good” as her sisters. The psychiatrist felt that high levels of sensitivity and perfectionism contributed directly to the development of her eating disorder.

Emily’s case exemplifies a number of issues related to gifted adolescents. Girls are less likely than boys to be identified for gifted programs and may not be identified at as early an age. Emily lost many years of attention that might have spared her some of the difficulty she faced in adolescence. Like many other gifted children who have learning disabilities, Emily’s giftedness masked her disability until she reached a higher academic plateau. Then she had to confront the fact that she could not perform as well as her sisters. Gifted children often have a sense of perfectionism, in which they make exceptionally high demands on themselves. Additionally, they often display a high level of emotional sensitivity and intensity. When Emily was stressed by the realization that her intellectual strength was imperfect, her perfectionism and emotional sensitivity combined to contribute to the development of her eating disorder.

Emily’s parents had high academic expectations of her and her sisters. Parental involvement in the continued development of gifted adolescents is very complex. On the one hand, there are major issues that require close parental attention, such as advanced placement courses, magnet programs, early college enrollment, and ongoing participation in special clubs, groups, and contests. On the other hand, parents must respond to the normal developmental need of their adolescent to separate and individuate. Gifted youth, like all others, must be allowed to move out into the world while their parents anxiously look on from a distance. It is clear that giftedness places an added burden on parents and child during this difficult transition.

Discussion

Each of these three children demonstrated giftedness in a different way, and each raised specific issues for his or her family and pediatrician. They emphasize that giftedness is not a simple, uniform condition, with consistent findings and a predictable course. However, they do demonstrate some relatively common traits of gifted children. Many of these children exhibit advanced language and verbal skills and are readily identified by the physician. Gifted children grasp concepts intuitively and do not always display the more ordered, structured thought processes of their peers. Giftedness may occur in only one developmental domain, so developmental asynchrony must be evaluated when designing activities for a child. As with all children, individual temperament must be considered when assessing behavior and development. Gifted children often show high levels of emotional sensitivity and intensity, which when coupled with perfectionism, may create major management issues for themselves, their families, and their pediatricians.

Pediatricians are trained to provide an ongoing assessment of a given child’s physical, emotional, and intellectual development. We are accustomed to identifying children whose progress in any of these areas is delayed or worrisome. We can recognize a “problem” or diagnose a “delay,” and we can design a plan for its evaluation and management, all with the purpose of allowing the child to function as optimally as possible. Giftedness is not a disorder but, rather, a developmental variation. Identification of a gifted child is important so that the child will not experience difficulties mastering various milestones and landmarks. As pediatricians, we must offer diagnostic and management expertise to these very special patients.