How Many Underachieving Gifted Students Have Undiagnosed ADHD?

Gifted underachievement can stem from many sources, but little research has examined the overlap between underachievement and undiagnosed twice-exceptionality. In a 2020 study in Gifted Child Quarterly, “Pay attention to inattention: Exploring ADHD symptoms in a sample of gifted underachieving students,” authors Betsy McCoach, Del Siegle, and Lisa DaVia Rubenstein sought to better understand the root cause of gifted students’ underachievement by examining whether some underachieving gifted students exhibited clinically significant symptoms of attention-deficit hyperactivity disorder.

 

As the authors noted, it is critical to identify the root cause of underachievement to determine appropriate interventions.  Students who underachieve because they are bored and underchallenged need different interventions and supports than students who underachieve due to neurologically-based attention deficits that interfere with learning.

 

For their study, Drs. McCoach, Siegle, and Rubenstein recruited teachers from 85 different schools who helped identify gifted students in grades 5 through 12 who were underachieving in reading/language arts and/or math.  Students qualified as underachieving if they performed in the bottom half of their class or had a C average or below. Students who received special education services or who were identified with learning disabilities were not eligible for the study. 

 

Students’ teachers and parents completed ratings of ADHD symptoms and students answered questions about their goal valuation, self-regulation, and self-efficacy.  Goal valuation is students’ belief that doing well in school is important; self-regulation is their ability to set and pursue goals and monitor their own progress towards those goals; and self-efficacy is their belief they can accomplish a task.  Students with stronger goal valuation, self-regulation, and self-efficacy typically perform better in school.  Students’ schools provided course grades.

 

Among the 212 underachieving gifted students who participated, well over half (62%) met criteria for clinically significant attention issues at home, at school, or in both settings.  Students’ symptoms were primarily related to inattention, not hyperactivity.  Approximately 19% of the underachieving gifted students in the study—almost 1 in 5 students—had elevated inattention scores at both home and school, which far exceeds the typical rate of inattention in the school population.  As the authors noted, these students are the ones most likely to meet criteria for a diagnosis of ADHD, should they be referred for a medical diagnosis or neuropsychological evaluation, because a diagnosis of ADHD requires that symptoms be present across multiple settings, such as home and school.  If a student has attention difficulties in only one setting, their symptoms may be due to boredom, anxiety, or other situational factors and not due to a neurologically-based attention deficit. 

 

Among the underachieving gifted students in this study, inattention symptoms were not only common but also appeared important for students’ motivation and performance.  Underachieving gifted students whose parents reported significant inattention symptoms were less likely to believe doing well in school is important and reported poorer self-regulation and lower academic self-efficacy than underachieving students without elevated inattention scores from parents.  Underachieving gifted students with elevated inattention scores at school or at home also tended to earn lower grades, even though their IQ scores and time spent on homework were equal to those of the underachieving students without significant inattention.

 

Overall, these results suggest that many gifted students who underachieve could in fact have undiagnosed ADHD, inattentive type.  The authors recommended the following for parents and teachers:

 

• Pay attention to inattention.  As their article’s title emphasizes, it’s critical that teachers and parents pay attention to inattention symptoms, particularly when gifted students underachieve.  The underachieving gifted students in this study had low rates of hyperactive behaviors but high rates of inattention.  Inattentive behaviors such as careless mistakes, lost materials, and difficulty remembering directions are often less disruptive than hyperactivity and impulsivity.  Parents and teachers may not notice these symptoms or may not find them particularly worrisome.  The results from this study, though, suggest that inattention symptoms have important implications for students’ achievement, motivation, and self-perceptions.  See the list at the end of this article to learn more about inattention symptoms associated with ADHD.

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• Refer underachieving gifted students for ADHD screening and testing more often.  As the study authors noted, “school personnel and parents should consider screening for ADHD more frequently when gifted students underachieve in school, especially when parents report inattentive behavior in the home.”  Information from a screening or thorough ADHD assessment may be necessary to help educators and families choose an appropriate intervention, because effective interventions vary based on students’ diagnoses.

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• Match interventions to students’ needs. Not all underachieving gifted students with inattention symptoms have ADHD.  In this study, teachers reported significant inattention in almost 50% of underachieving gifted students, but just under 30% of parents reported significant inattention symptoms at home.  Underachieving gifted students who are inattentive at school but not at home likely need changes to the school environment, such as more challenging or high-interest curriculum.  The authors emphasized that for underachieving gifted students with true attention deficits at home and school, “interventions…should target attentional issues as well as curricular issues” and may include medication or specific learning or organizational strategies to manage symptoms of ADHD.

 

The authors of the study also noted that gifted professionals should receive specialized training to help identify gifted students who may qualify for a diagnosis of ADHD and who may be underachieving because of their struggles with attention. 

 

Unfortunately, teachers and parents may not be aware of common inattention symptoms associated with ADHD and may attribute these symptoms to other characteristics or willful behavior. In my experience as a therapist and assessment provider, parents and teachers have sometimes misinterpreted inattention symptoms as laziness, willful carelessness, low motivation, manipulation, or lying.  Such misunderstandings can cause significant stress or shame for the undiagnosed child and for their parents and teachers, who often care about the child and dislike their own frustration with the child’s behaviors.  Therefore, I agree with the authors that more education is needed to inform teachers and parents about common inattention symptoms and appropriate interventions.

 

So, what are some examples of inattention symptoms that may be related to ADHD?  The study summarized above used a rating scale based on the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV-TR), but the symptoms are similar to those in the current edition, the DSM-5.  According to the DSM-5, symptoms associated with ADHD, inattentive type include:

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

• Often has trouble holding attention on tasks or play activities.

• Often does not seem to listen when spoken to directly.

• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

• Often has trouble organizing tasks and activities.

• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

• Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

• Is often easily distracted

• Is often forgetful in daily activities.

 

If you recognize your own gifted child in these criteria, consider pursuing additional screening or testing for ADHD with the child’s pediatrician or with a psychologist or neuropsychologist. If you work with gifted children and recognize these symptoms, consider recommending further assessment.

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If you suspect or know that your gifted child has ADHD, you likely have questions about effective parenting strategies, helpful supports, or whether to pursue more assessments or services. I encourage you to schedule a free 20-minute phone call with me to discuss your situation and discuss whether my 1:1 parent consultation services would be a good fit. You may also be interested in my article Your Child Isn't Lazy and Neither Are You.

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This article was originally published on 2eNews.com with the title "Gifted Underachievers with Undiagnosed ADHD."