Till startsida
University of Gothenburg
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QUESTION 1

BACKGROUND

I am writing with some queries on the relationship between DAMP and high intellectual ability/giftedness. These relate to my son who is 7. Several assessments have shown he has: inattentive ADHD, DCD, dysgraphia, joint hypermobility and sensory processing difficulties. He meets the criteria for DAMP, but we are outside Sweden and awareness of DAMP is low where we live. He was also assessed as highly gifted, testing in the ceiling range of both the Wechsler WPPSI and WISC-IV tests.

QUESTION:

What is known about the relationship between intellectual giftedness and DAMP?

ANSWER:

Thank you for your e-mail. Your questions are highly topical and I would recommend you to read the following two papers on this subject:
”Is attention deficit hyperactivity disorder a valid diagnosis in the presence of high IQ? Results from the MGH Longitudinal Family Studies of ADHD.” by Antshel KM and colleagues in Journal of Child Psychology and Psychiatry 2007 48(7):687-694 and
”An evidenced-based perspective on the validity of attention-deficit/hyperactivity disorder in the context of high intelligence.” by Rommelse N and colleagues in Neuroscience and Biobehavioral Review 2016 71: 21-47

Since the diagnostic manual DSM-III-R was launched in 1987 ADHD has become the term of choice, and clinicians and researchers in the Nordic countries consider DAMP to be equivalent with ADHD + DCD.
ADHD can be more difficult to recognise in highly gifted children and therefore the number of individuals in this population is probably underestimated. The reason why these individuals are not diagnosed with ADHD/DAMP can in some cases be that the functioning does not seem to be reduced, but without the ADHD symptoms the individual would have been able to have a higher function and would have been able to use his/her skills in a much better way.

QUESTION:

Some authors refer to "masking" and "compensation" effects whereby giftedness and specific learning difficulties/disabilities hide each other, so that neither is diagnosed; only an "average" is seen, or the severity of one or both conditions is underestimated. What might be expected in the case of giftedness + DAMP?

ANSWER:

This is also true in the case of giftedness and DAMP. To quote Rommelse: “several behavioral characteristics appear to strongly diverge in highly intelligent individuals and those with ADHD, foremost ‘learns rapidly’, ‘self-starter’, and ‘observant’”

QUESTION:

How do the difficulties associated with DAMP complicate assessments of cognitive ability, or is there a best practice for cognitive assessment when DAMP is known or suspected, specifically:
a) Should alternative WISC indices, e.g. General Ability Index (or GAI and CPI) be emphasised rather than FSIQ when assessing intellectual potential and educational need? In the case in question, there were large differences between the composite indices with working memory and processing speed much lower than verbal comprehension and perceptual reasoning.
b) Given that the WISC FSIQ is influenced by tests with significant fine motor/graphomotor loading, if significant dysgraphia, fine motor difficulties and joint hypermobility are present, should a priori subtest substitutions be considered (e.g. replace coding/block design by alternative tests with lower fine motor sensitivity)?
c) The WISC-IV has a 40% weighting on processing speed and working memory, whereas WISC-III and WISC-V had lower weightings (20% and 28% respectively). Does this mean WISC-IV is more strongly affected by difficulties associated with DAMP than other WISC versions? Might other tests with fewer timed items and less fine motor loading (e.g. Stanford Binet?) give a better estimate of cognitive potential?

ANSWER:

The Wechsler scales were originally designed to measure intellectual ability and not as a neuropsychological test battery. With the inclusion of indexes different neuropsychological strengths and difficulties can be evaluated. The GAI provides an estimate of general intellectual ability, with reduced emphasis on working memory and processing speed relative to the FSIQ. According to my clinical experience both FSIQ and GAI are important to consider and enriches the clinical evaluation. The calculation of Full scale IQ in WISC-IV is based more heavily on the processing speed index and working memory index compared with WISC-III so using GAI, which will show the individual’s overall cognitive ability, might complete the picture of the child’s intellectual ability. You can read further in Prifitera, A., Saklofske, D. and Weiss, L. (2011). WISC-IV Clinical Use and Interpretation. Burlington: Elsevier Science

QUESTION:

4) Likewise, could the compensating effects of high intelligence result in the severity of the underlying DAMP being underestimated?

ANSWER:

See 1)

QUESTION:

DAMP is known to have a greatly enhanced risk of poor outcome. Some authors also regard the highly/exceptionally gifted as an at-risk group with increased vulnerabilities to social and relationship issues and depression and increased likelihood of experiencing inappropriate educational provision. Should a child assessed as being both highly gifted (IQ >= 145) and having DAMP be regarded as being at particularly heightened risk?

ANSWER:

According to Rommelse and colleagues “the available studies suggest that ADHD in highly intelligent individuals has a comparable course to ADHD in average IQ individuals with the possible exception of being at lower risk for conduct-related or substance use disorders.”

QUESTION:

What educational provision should be considered for a highly gifted child with DAMP? Specifically, his level of ability in mathematics, reading and several other areas is exceptionally high (5+ years ahead of age) but he also has significant writing problems/dysgraphia, issues with fine and gross motor control, inattention, lack of consistency and a slow pace of work. What guidance can be given to teachers in providing for this extreme pattern of strengths and weaknesses?

ANSWER:

Pedagogy always needs to be adapted to the child's strengths and weaknesses. A child with superior skill and knowledge needs to have an educational level according to his/her ability and adjustments need to be made according to the child’s weaknesses. The child might probably have to practice the "problematic" areas; however, this should not affect other subjects. There is a time for practicing writing, but in other subjects, e.g when doing math, aids like computer should be provided so that the focus will be on the targeted subject and not on the weakness. Short well-structured working assignments that are intellectually challenging are strongly recommended.

QUESTION:

Under what circumstances would a trial of stimulant medication be appropriate? Specifically if the child is functioning educationally above chronological age due to compensation, but below potential as indicated by WISC scores, and it therefore appears on the basis of the latter that the degree of impairment is significant, should a trial of stimulant medication be considered?

ANSWER:

Yes, that is possible.

EVA BILLSTEDT


 

Page Manager: Anna Spyrou|Last update: 11/21/2017
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