Patient Presentation
An 8-year-old male came to clinic for his health supervision visit. His parents had no specific health related questions but they had questions about his schooling. He had taken a national test for 3rd grade students in the fall and he had qualified for the school’s gifted and talented program for the next year. The parents wanted to know if this was a good idea or “if this is just going to make him different from all the other kids.” The past medical history noted that he had been an early talker and reader and would play with plastic building blocks for hours never following the package instructions and making his own creations. His parents said he wore them out by asking “why?” all the time. The family history showed that the parents had finished college doing so on a part-time basis because of financial constraints. The father also was taking distance-learning classes.
The pertinent physical exam revealed a healthy male with normal growth and vital signs. The diagnosis of a healthy male was made. The pediatrician said that the boy’s test scores seemed to be confirming what the parents probably already knew: that he was a talented individual who wanted to delve deeper into the world around him and learn more about it. He noted that this was what gifted and talented education programs are supposed to do is to provide for the needs of gifted students who can learn at a faster pace and deeper level compared to their peers. He also suggested that the parents set up a meeting with the program’s teacher to learn more about how it could benefit their son. As far as making him different, the pediatrician noted that this is a common myth that the children are very different than their peers socially. In most schools, children are moved between different groups and classrooms all the time to help meet the needs of all the children. Again, talking with the teacher to understand how this occurs in his school probably would be helpful. The pediatrician said, “It can be overwhelming sometimes to parent a gifted or talented child. It helps to learn more about it, so I’ll write down a couple of Internet websites where you can start to get more information. There are probably a few other parents in the school that you can talk with too. I also recommend that you take him to the library regularly. He’s old enough to look up information about what is interesting him and learn more about it. The librarian and you can guide him but he can do most of it. Plus the library is free to use.”
Discussion
One of the problems with understanding giftedness is the definition. The National Association of Gifted Children uses the following comprehensive definition:
- Gifted individuals are those who demonstrate outstanding levels of aptitude (defined as an exceptional ability to reason and learn) or competence (documented performance or achievement in top 10% or rarer) in one or more domains. Domains include any structured area of activity with its own symbol system (e.g., mathematics, music, language) and/or set of sensorimotor skills (e.g., painting, dance, sports).
The United States Federal government uses a narrower, more educationally-focused definition:
- The term gifted and talented student means children and youths who give evidence of higher performance capability in such areas as intellectual, creative, artistic, or leadership capacity, or in specific academic fields, and who require services or activities not ordinarily provided by the schools in order to develop such capabilities fully.”
To complicate the matter further, each state in the United States there is a different definition again primarily used for education.
Data supports giftedness as genetic but also with ambition and opportunity being important factors in the long-term accomplishments of gifted individuals. Individuals can be identified early in life but variability of presentation is common and each child will not show giftedness in all areas. Some children will show their giftedness early and others may be late bloomers revealing their promise in adolescence. Individuals may also be gifted and have other learning disabilities or developmental or behavioral/psychiatric problems and are often referred to as “twice-exceptional.” These individuals may not be identified as gifted because their problems mask the giftedness. Conversely, the giftedness may mask their problems.
For gifted children, encouraging their specific strengths and talents helps these children excel. For twice-exceptional individuals, supporting the problems while encouraging the giftedness provides the best opportunities for them to excel too. There are several common myths about gifted children including that academic acceleration is bad for gifted students when it should be considered for many individuals and there are rating scales to help with these decisions. Another myth is that many gifted individuals have psychiatric disorders when most are well adjusted children and adolescents.
Learning Point
Gifted children can present in a number of ways including:
- Asynchrony across developmental domains
- Advanced language and reasoning skills
- Conversations and interests more aligned with older children and adults
- Impressive long-term memory
- Intuitive understanding of concepts
- Ability to hold problems in mind that are not yet figured out
- Insatiable curiosity
- Advanced ability to connect disparate ideas, and appreciate relationships
- Rapid learning
- Heightened sensitivity and intensity of feelings and emotions
- Perfectionism
- Moral sensitivity
- Advanced humor for age
- Pleasure in solving and posing new problems
- Capacity for independent, self-directed activities
- Talents in specific areas (e.g. drawing, games, math, music, reading)
Questions for Further Discussion
1. How does your local school district accommodate gifted children in the classroom?
2. What local resources are available to identify and assist gifted children and their families in your area?
Related Cases
- Disease: Gifted Children | Family Issues | School Health
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Specialty: School
- Age: School Ager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for these topics: Family Issues and School Health.
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
Pfeiffer SI. The gifted: clinical challenges for child psychiatry. J Am Acad Child Adolesc Psychiatry. 2009 Aug;48(8):787-90.
Lubinski D. Exceptional cognitive ability: the phenotype. Behav Genet. 2009 Jul;39(4):350-8.
Liu YH, Lien J, Kafka T, Stein MT. Discovering gifted children in pediatric practice. J Dev Behav Pediatr. 2010 Apr;31(3 Suppl):S64-7.
National Association for Gifted Children. Redefining Giftedness for a New Century: Shifting the Paradigm. Available from the Internet at http://www.nagc.org/index.aspx?id=6404 (rev. 2010, cited 2/4/14).
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
4. Patient management plans are developed and carried out.
5. Patients and their families are counseled and educated.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
18. Using effective nonverbal, explanatory, questioning, and writing skills, the healthcare professional uses effective listening skills and elicits and provides information.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
Pediatric Education 