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Twice Exceptional: Over-Identification of ADD/ADHD in the Gifted

by Deborah L. Ruf, Ph.D.

(Originally published in the NAGC newsletter for Guidance & Counseling Division, 2001, with the title Twice Exceptional in the Gifted)

In a little over one year of private practice as a gifted specialist I have confronted the issue of ADD, Attention Deficit Disorder, and ADHD, Attention Deficit Hyperactivity Disorder, myriad times. The first disability involves a high level of distractibility, an inability to focus on one topic and follow it through. ADD manifests itself in the person’s starting but not finishing assignments and projects, and not hearing and remembering what one has been told, for example. ADHD generally includes all the qualities of the first disability but also encompasses hyperactivity. A child with ADHD shows excessive activity, especially activity unrelated to what needs to be done or what is expected and desirable behavior.

As far as twice exceptional is concerned, ADD/ADHD is a problem in that the definition and diagnosis can often take the place of recognizing that the child is gifted and misplaced in his academic environment. The child can be put on medication that calms him down and makes him less susceptible to distractions, but the subsequent compliance may take away the zest and curiosity that are a strong hallmark of high intelligence and creativity. It is possible that high intelligence on medication turns itself toward adding complexity to lower level instruction and activities.

Conversely, when children are ADD or ADHD and undiagnosed, life can be more difficult for them and they may go unrecognized as gifted. It is my professional opinion that a highly gifted child who is ADD/ADHD can learn to cope with the concomitant attention difficulties, but that his energies are sapped to the point of disabling him to function as high as he could if on treatment.

The frequency with which the topic arises has necessitated my reading articles, visiting web sites, and talking at length to medical and psychological colleagues in order to familiarize myself with the condition. Almost always, it is the parents of boys who tell me that the school suspects ADHD in their son. The parents learn as much as they can about ADD/ADHD, and the people who call me want to determine first if their son may simply be gifted. Poor academic fit often causes lack of follow-through; and the generally high activity and wide interests of gifted children may make them appear to be too active or distractible.

I have some background working with boys. I have two brothers and have raised three sons, all of whom are gifted and very, very busy, and some have said, “hyper.” I have taught elementary school and am familiar with the higher activity level of boys in general. I mention this because I have a good sense of what is normal for bright children when it comes to ability to concentrate and activity level. If a child truly experiences ADD, he cannot focus on school instruction even when the environment and instructional level are completely appropriate for him. During a one-on-one testing situation with me, I can tell whether or not the child has difficulty with attention and focus, it is likely to evidence itself during our time together. I have a strong bias, after many years of study and experience, toward believing that most children whom the schools and parents believe are ADD, instead are experiencing difficulty attending to and following through on assignments and materials that are below what they are ready to study and address. Obviously it occurs more often in gifted children that the instruction is indeed boring and repetitive. For a number of reasons that are not the focus of this article, most gifted girls cope with inappropriate instruction better than do most gifted boys. Out of approximately 125 children with whom I have worked professionally in the past year, there were only two that I recommended be tested medically for possible ADD or ADHD.

Gifted children sometimes appear to have trouble understanding instruction and focusing because they are baffled by the instruction and expectations. It is difficult for them to believe that this is truly all they have to do to finish the assignment. There must be some catch, some trick; it couldn’t be this easy. Many gifted children simply refuse to do the busywork of an assignment when there is clearly nothing to be gained beyond the teacher’s approval. Unfortunately, some of these circumspect and independent children fall into a pattern of noncompliance that ill-equips them to recognize when the assignments may actually be helpful and useful.

Among gifted children who are referred for ADD/ADHD assessments, it is boys who eventually test at over 140 IQ who are most frequently mislabeled and sometimes misdiagnosed as being ADD/ADHD. My feeling is that a borderline or questionable case of ADD/ADHD first needs to be addressed by checking the intellectual functioning level of the child, then the educational environment and its appropriateness for the child’s ability level, and finally, that the child should be given support in understanding how to deal with occasional frustrations in school or at home. Sometimes parents benefit from taking parenting classes or reading books on parenting.

It is unfortunate but true that medical professionals, school personnel, and counselors are often unaware of the characteristics and needs of gifted children. The proportion of children who are on medication for ADD/ADHD now compared to 20 years ago is many fold larger. I believe that creativity is jeopardized, personalities are unnecessarily reigned in, and the long-term affects of being on medication instead of learning how to deal with distractions that are a part of every day life have not yet been calculated. I believe it is normal for a highly intelligent person to be unusually sensitive to things around him or herself. The individual needs to have practice in following through on things that matter and things that are meaningful. It is important to learn how to budget one’s time, and to manage many interests, activities, and obligations. Highly intelligent people can juggle far more activities and interests than people who are less intelligent. It is normal for most gifted children and adults to sometimes have trouble finding a good and healthy balance. In my professional opinion, however, ADD/ADHD is over diagnosed among the gifted and is often erroneously viewed as a twice exceptional condition.

This article has been reprinted with permission from the author.   Deborah Ruf, Ph.D., is a specialist on gifted children and adults for Educational Options, and President of Talent Igniter, home of the Ruf Estimates™ of Levels of Gifted, an online screening tool for parents. Her book, 5 Levels of Gifted: School Issues and Educational Options (2005) summarizes “levels of giftedness” and highlights highly to profoundly gifted children. See
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How Smart Is My Child?

By Deborah L. Ruf, Ph.D.

Many parents wonder how their children compare to other children. They may have very good reasons to suspect their children are gifted (for example, their two-year-old already knows letters and numbers or their three-year-old can read an “Exit” sign), but they’re not sure if it’s unusual or not. But, information about intelligence levels can be critical, because it helps parents to understand what their children’s needs are and to provide more opportunities for their kids’ increased growth, enjoyment, and success in areas of interest

There are certain childhood behaviors — milestones — that can tell us when children are ahead of or behind others their age. Most of the charts on childhood development show the typical range of behaviors for each age group. If your child is ahead of those tables, that doesn’t necessarily mean he or she is on the fast track or slated to inspire the next Big Bang Theory. Levels of Giftedness range from those who are simply bright to those who are intellectually astonishing.

Here’s an overview of the various levels of giftedness and milestones that are common—but not necessary—to each Level. Here, also, are the numbers at each Level of Giftedness that you are likely to find in an average elementary classroom of 28 children. It is the overall “feel” of where the child fits that tells you the Level.

Level One

  • These children show interest in many things before they are even two years old – like colors, saying the numbers in order, and playing simple puzzles.
  • Most of them are good talkers by age three, and by four, many print letters and numbers, recognize simple signs, their name, and know most of alphabet.
  • By the time they are six years old, many read beginner books and type at the computer, and most read chapter books by age seven.
  • It is not unusual to find six to eight Level One children in an average classroom, children who are nearly always a few steps ahead of what the teacher is teaching the whole class.

Level Two

  • These bright children love looking at books and being read to, even turning pages without ripping them, by 15 months. Some shout out the name of familiar stores as you drive past.
  • Many of these children know lots of letters by 18 months and colors by 20 months, and between ages three and four, they count small groups of objects, print some letters and numbers, and they very likely drive their parents crazy with all their questions.
  • They’ll sit for what seems like hours as you read advanced level books, especially fiction and fantasy, to them, but they require a bit less of your time by age six, because most of them read for pleasure and information on their own by then.
  • Level Two children can find only one or two others in their classroom who are as advanced as they are, which starts to make it hard to find good friends.

Level Three

  • They’re born wide-eyed and alert, looking around the room, reacting to noises, voices, faces.
  • They know what adults are telling or asking them by six months. You say a toy, pet, or another person, and they will look for it.
  • Everything Level Two children do by 15 months, these kids do by 10 to 12 months, and they can get family members to do what they want before they are actually talking.
  • By two years, many like 35+ piece puzzles, memorize favorite books, and know the entire alphabet – in or out of order!
  • By three years old, they talk constantly, and skip count, count backwards, and do simple adding and subtracting because they like to. They love to print letters and numbers, too.
  • They ask you to start easy readers before five years, and many figure out how to multiply, divide, and do some fractions by six years.
  • Most of these children are a full two to five years beyond grade level by age six and find school too slow.
  • There are one or two Level Three children in every 100 in the average school. They are rarely in the same elementary class and can feel very, very lonely.

Level Four

  • Level Four babies love books, someone to read them, and pay attention within a few months of their birth.
  • They are ahead of Level Three children by another 2 to 5 months while less than two years old.
  • They have extensive, complex speaking by two years, and their vocabularies are huge!
  • Most of them read easy readers by 3½ to 4½ years, and then read for information and pleasure by age five, with comprehension for youth and adult level books at about 6 – 6½ years.
  • There are about one per 200 children in the average school. Without special arrangements, they can feel very different from their typical classmates.

Level Five

  • Level Fives have talents in every possible area. Everything is sooner and more intense than others Levels.
  • They have favorite TV shows before 6 – 8 months, pick out letters and numbers by 10-14 months, and enjoy shape sorters before 11 months.
  • They print letters, numbers, words, and their names between 16 – 24 months, and often use anything that is available to form these shapes and figures.
  • They show ability with 35+ piece puzzles by less than 15 months and interest in complex mazes before they are three.
  • Musical, dramatic, and artistic aptitudes usually start showing by 18 months.
  • Most speak with adult-level complexity by age two.
  • At two and three-years-old they ask about how things work, and high interests in science – particularly biological and life and death questions – emerge.
  • They understand math concepts and basic math functions before age four.
  • They can play card and board games ages 12 and up by age 3½ to 4.
  • They have high interest in pure facts, almanacs, and dictionaries by age 3½.
  • Most read any level of book by 4¼ to five years.
  • They read six or more years beyond grade level with comprehension by six years and usually hit 12th grade level by age 7 or 8.
  • We know they occur more often than once in a million and regular grade school does not work for them. Levels Three through Five score similarly on ability tests—very high.

Once you have a sense of your children’s abilities, you can provide them with more activities and experiences that build on these strengths and take advantage of their talents. Parents who have more than one child may notice that each child seems to have different interests and talents even when we encourage them equally. This is because we don’t cause our children’s abilities; we can only recognize and nurture them. To do less is truly depriving them of chances to do what they are good at and what they enjoy. To do less for our children probably chips away at their potential, too, for how can we get good at the things we don’t get to practice? There are more potential geniuses – children who are remarkably intellectually different from their same-age classmates – than most people believe, and your child may well be one of them.

This article has been reprinted with permission from the author.   Deborah Ruf, Ph.D., is a specialist on gifted children and adults for Educational Options, and President of Talent Igniter, home of the Ruf Estimates™ of Levels of Gifted, an online screening tool for parents. Her book, 5 Levels of Gifted: School Issues and Educational Options (2005) summarizes “levels of giftedness” and highlights highly to profoundly gifted children. See
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Critical Thinking Resource: Pieces of Learning

When it comes to critical thinking and science, Pieces of Learning has some great supplemental texts!  In case you haven’t heard of Pieces of Learning, I wanted to let you know that they specialize in differentiated learning.  Differentiated learning is individualized to meet the unique needs of students, which is exactly what homeschooling is all about.  With a background in gifted education, Pieces of Learning has been offering high quality resources for students and teachers since 1989.  According to them, “Our products will always make kids and educators THINK – at a higher level”  

Within the science section of their website, they carry the Challenging Puzzle series, which are filled with critical and creative reasoning problems.
According to their website, “[w]hen deductive and creative thinking puzzles are linked to content they can be used to:

  • teach facts
  • teach content vocabulary
  • reinforce research skills 
  • motivate students”
“Critical and creative reasoning puzzles can be used as curriculum extensions and as anchor activities in the differentiated classroom, for pre and post testing, or as an introduction to a new unit.”
Here are some of the titles Pieces of Learning carries in the Challenging Puzzle series:

Also, check out Primary Science Readers’ Theatre and The Scientific Method in Fairy Tale Forest, among many other titles, and not just in the field of science!  

If you have used any of these books in your homeschool, I’d love to hear about it— leave a comment!