Giftedness and Clinical Diagnoses - Untangling the Threads.

It’s been a while since I last did a blog post. This one has been playing on my mind for some time, particularly after speaking to my occupational therapy colleagues who work in mental health during the OTNZ-WNA conference (that was nearly a year ago – where has the time gone?!). One of the things these fabulous clinicians kept asking me was:

  • How do we, as clinicians, make sure that we recognise gifted individuals within our practices?

  • Once we’ve identified that a child or adult may be gifted, what can we do to help them within our service specifications?

A common question we, the gifted community, also ask is “do gifted individuals experience mental health issues more commonly than the neurotypical population?” (NB: Neurotypical is commonly used to identify people who do not have autism, ADHD, giftedness and other neurological differences; for the purposes of this article, and the articles referred to, ‘neurotypical’ means not gifted).

You can imagine my (admittedly very geeky) excitement when I stumbled across a large study published in the magazine ‘Intelligence’ earlier this year! The 2018 article High intelligence: A risk factor for psychological and physiological Overexcitabilities by Karpinski et al outlines the rate of people of high intellect experiencing a range of mental health conditions (reported and diagnosed), along with proposing a brilliant model for practice.

The study included 3715 individuals who were already members of Mensa America (therefore, formally identified as gifted). A range of genders, age and ethnicity were represented, but most participants were older European American men.

From a New Zealand perspective, we must consider cultural differences between Kiwis and Americans, particularly as New Zealanders often take a ‘she’ll be right’ approach to their mental health, and avoid standing out (good old Tall Poppy Syndrome) where Americans may be more willing to explore pathology, psychological differences, and actually join Mensa. For this reason, the numbers and experiences reflected within this study are compelling, but the numbers may not replicate exactly within the New Zealand context.

The number of participants reporting either diagnosis or experiencing symptoms of diagnoses as listed in common diagnostic questionnaires is listed in the chart below. The blue columns represent the number of people in the general population who would have been expected, statistically, to be diagnosed with each condition from the same size group as this study. The red columns include participants who suspected they had each condition, along with those who have been formally diagnosed.

Psychological Overexcitabilities (Mood Disorders, Anxiety and ADHD)

The results found by Karpinski et al support the work provided by Dabrowski, finding that intense emotional responses to the environment can lead to individuals experiencing increased rumination (ongoing, repetitive thoughts) and worry. Both these traits have been associated with higher cognitive ability. Rumination is a predictor of chronic depressive disorders and anxiety symptoms. People who have a tendency for highly repetitive thoughts are also at higher risk of major depression, with severity increasing as the intensity and frequency of their rumination increase.

Kessler et al. (2006) found that adults with ADHD often present with comorbid conditions, including anxiety (47%) and mood (38%) disorders. What greatly concerns me when working with gifted individuals is that participants with high intelligence who experience psychomotor overexcitabilities (the need to move and/or fidget) are most often diagnosed with ADHD because of a lack of knowledge of this natural gifted trait. Long term, people are less likely to be recognised (including by themselves) for their intellectual ability, instead feeling like they don't quite fit and not having the opportunity to explore their potential.

Physiological overexcitabilities: The Stress Response, Allergies and Immunity

For highly intelligent individuals with overexcitabilities, even normal sensory experiences, like tags on clothing, background sounds or artificial lighting can be physically painful.

Continuously being exposed to these experiences, such as at school or in the workplace, can mimic minor chronic stress, causing a physiological response. Just like real threats to the body, such as infections or injury, the body perceives danger, triggering a continuous fight/flight/freeze response which can then trigger hormone changes causing changes in the immune system. “We are learning that stress has a significant effect on the ability of the immune system to protect us and consequences can take many forms including allergies, asthma, and autoimmune disease.” (Karpinski et al, 2018). Heightened adrenaline and stress hormones also alters an individual’s ability to respond to sensory information, as their body is primed to fight or run away from a perceived threat, or freezes and is unable to respond.

High Intellectual Ability and Autistic Spectrum Disorders (ASD) – A genetic link.

A study by the Psychiatric Genetics Consortium regarding the genetic risk for ASD was calculated within a large (nearly 10,000) group of individuals, finding that the genetic risk of experiencing ASD (even if people did not develop the disorder) correlated with high intellectual ability. Individuals were noted to particularly excel in the areas of logical memory, verbal fluency and vocabulary.

“The highly intelligent individual has a remarkable capacity for seeing and internalizing these vast uncertainties, possibilities, and problems. This gift can either be a catalyst for empowerment and self-actualization or it can be a predictor of dysregulation and debilitation as the present results suggest. If these individuals take in their world in such an overexcitable manner intellectually (hyper brain), then the potential exists for an intense level of physiological processing as well (hyper body).”

Karpinski et al, 2018

As parents and clinicians, what can we do?!

Firstly, reading all this information may cause parents to become increasingly concerned that their child is at high risk of a mental health crisis – this is not necessarily the case. Remember – everything is on a spectrum, and the traits described above are only an issue if they get in the way of a child doing the things they would normally be able to do, or enjoy doing.

If you find that your child is experiencing stress which gets in the way of them learning, playing or completing routines, try some of the simple strategies available through support networks such as your local gifted association, or joining gifted parent support groups online. If these are not effective, get in touch and lets see if we can point you in the right direction for further support - it may be a chat and a link to some information is enough. If not, there are a range of clinicians such as occupational therapists, psychologists and speech language therapists who can help children manage their stress and anxiety levels.

For clinicians, Karpinski et al have designed a model of practice (Hyper brain/hyper body theory of integration) which suggests that the ‘hyper brain’ of those with IQ over 130 (i.e., gifted individuals) is wired to respond to environmental stressors by ruminating and worrying, warning signs that an individual may experience psychological overexcitabilities sufficient to lead to an affective disorder. These are closely linked with a ‘hyper body’ (physiological Overexcitabilities) which can present as immune and inflammatory dysregulation, further impacting on an individual’s mood.

This is an intriguing model of practice which has the potential to provide a holistic framework to assess and support gifted individuals within clinical (medical and allied health) roles, recognising that their high intellect influences their emotional experience and physiological regulation, along with the environmental demands placed on the individual. This fits well alongside occupational therapy models of practice such as the Canadian Model of Occupational Performance and the Person-Environment-Occupation Model which consider all demands placed on an individual, and supports available, within the things they need and want to do and the places we do them.

Some particular considerations for clinicians if they suspect their client may be gifted:

  • Where a child is suspected to have ADHD due to their activity levels (particularly excessive movement), the presence of psychomotor overexcitability and high intellect should be considered to ensure they are supported to explore their intellectual strengths while also being able to explore movement. The goal with gifted individuals is not to remove their overexcitability, but to give them the skills and awareness to harness their energy within the contexts they live, work and play.

  • Be aware of factors in the child's environment which may cause increased stress, particularly if they seem to spend a lot of time in fight/flight/freeze mode, making it difficult for their body to differentiate between real and perceived threats when they experience sudden, increased stress.

  • Use of mindfulness and sensory modulation strategies could be considered to assist children and adults to be more aware of their internal and external experiences, and give them tools to move out of fight/flight/freeze quickly and effectively.

  • Cognitive behaviour therapy may be helpful in assisting individuals to recognise their thought patterns, particularly habits such as ruminating or worrying, and identify strategies to adapt these patterns.

  • Environmental adaptations may assist children to be able to pay attention to essential tasks and information. This may include advocating for acceleration or extension to ensure children receive the level of intellectual and creative challenge required to assist them to relax.

  • Ensure that adults seeking assessment are supported to explore their giftedness as an aspect of their past development and their current identity, alongside treatment for other diagnoses. This may include setting goals related to engaging in interests which they have put aside in the past, or have never thought to pursue.

If you are concerned that your child or teen has increased stress as a result of possible giftedness, or you’re not sure which diagnostic path to pursue with a client, get in touch and let’s see if we can help you out.

Ruth I. Karpinski, Audrey M. Kinase Kolb, Nicole A. Tetreault, Thomas B. Borowski (2018). High intelligence: A risk factor for psychological and physiological Overexcitabilities. Intelligence (66) p 8-23.