CHAPTER 35

Gifted Children

Calla R. Brown, MD, FAAP, and Iris Wagman Borowsky, MD, PhD, FAAP

Addressing caregiver concerns about giftedness provides an exciting intersection of strengths-based pediatric medicine with the educational system. Because several definitions of giftedness exist, prevalence rates vary. Identification of gifted children coupled with advocacy can promote an optimal educational match for the child; however, identification systems currently in use may result in an underrepresentation of children from socioeconomically disadvantaged backgrounds. Pediatricians can help counsel families in the creation of a supportive environment for their children and can advocate on behalf of children and families within the educational system.

Giftedness has been defined in several ways. The psychometric definition of giftedness is based on scores obtained on standardized intelligence tests. The 2 most frequently used cutoff points are 2 standard deviations above the mean (intelligence quotient [IQ] of 130–135) and 3 standard deviations above the mean (IQ of 145–150). Children with these scores are in the upper 2% and 0.1% of the IQ distribution, respectively. Intelligence quotient, which is considered to be fairly stable after 3 or 4 years of age, is the best single predictor of scholastic achievement at all levels, from elementary school through college.

A second definition of giftedness is based on real-life achievements or performance of exceptional skills rather than test scores. Children with special talents (other than general intelligence) in areas such as music, mathematics, ice skating, chess, or drama fit this description. Other definitions of giftedness recognize motivation, commitment, perseverance, high self-esteem, and creativity as personality traits that allow children with above-average ability to develop exceptional talents. This collective group of traits is often referred to as the “potential to achieve” academic or other success.

Epidemiology

The prevalence of giftedness depends on the somewhat arbitrary definitions of giftedness and the varied approaches to the identification of gifted children. Traditional screening systems identify 3% to 5% of students for participation in gifted programs in schools. Some schools use an alternative system in which 10% to 15% of children are recognized as above average. With the goal of fostering giftedness in these children, schools offer them enriched programs.

Intellectual giftedness in children has been associated with the social, economic, and educational background of their families. Factors that correlate with higher IQ scores in children are more years of parental education, higher IQ scores of mothers, increased family income, smaller family size, and longer intervals between siblings. Children from low-income and minority backgrounds are less likely to be identified as gifted than other children. Black, Hispanic, and Native American students are underrepresented by 30% to 70% in gifted programs in the United States. In particular, when single intelligence testing is used to identify gifted children, students from diverse cultural backgrounds are more likely to be excluded from programming opportunities. Some studies have also found that teacher referral–based systems may be more likely to under-identify students from diverse backgrounds if most of the teachers have cultural or ethnic discordance with the student.

Although research indicates that, as a group, children who are academically gifted begin to walk, verbalize, and read earlier, this area of research is still in its infancy, and conflicting results have been reported. Thus, these factors are not useful for predicting giftedness in individual children.

Evaluation

One of the primary goals of child health promotion is developmental monitoring. The early identification of developmental delays, which allows for prompt intervention, is among the primary purposes of such monitoring. Techniques for developmental assessment include review of developmental milestones with parents and discussion of parental concerns, informal observation of children in the office, and formal screening with standardized tests, such as the Ages and Stages Questionnaires.

Identification of Gifted Children

Although parents’ first concern is usually to confirm that their child is developing normally, it is not uncommon for parents to ask if their child is gifted. Such questions are typically motivated by parents’ desire to optimally encourage their child’s development. Sharing information and observations with parents during developmental monitoring may facilitate parent-child interaction and child development. In a competitive society, the pediatrician should look for signs that above-average abilities are the result of undue pressures placed on children, such as incessant teaching or overscheduling of time.

Infancy and early childhood may not be the best time to determine whether a child is gifted. Age of attainment of developmental milestones and performance on standardized tests (eg, Bayley Scales of Infant and Toddler Development) during the first 2 years after birth are unreliable predictors of intellectual giftedness. Reasons for this lack of reliability may include weaknesses in the tests and variable rates of child development that result in transient precocity or delay. Tests that focus on visual memory tasks in infants may be better predictors of later academic intelligence, although additional research is required on the efficacy of such tests. Additionally, many special talents that comprise giftedness, such as creativity or artistic or musical ability, may not manifest until children are older.

The determination of giftedness in older children may involve several factors (Box 35.1). The early identification of giftedness allows for the development of an appropriate educational program that is optimally matched to a particular child’s ability to learn. Without early identification and intervention, children who are intellectually gifted may become disillusioned with school, lose interest in learning, fail to develop study skills because they are never challenged to think and work hard, and develop a pattern of under-achievement that may be difficult to reverse by the middle grades.

Special Groups of Gifted Children

Giftedness is harder to identify in some children. In the child with physical disability, giftedness is often obscured by the obvious physical disability, which demands attention. Such children may participate in special programs in which their physical needs are the major concern, to the detriment of their academic or artistic potential. In addition, poor self-esteem associated with the disability may prevent these children from realizing their potential. To identify giftedness in the child with physical disability, parents and teachers must make a concerted effort to search for potential and encourage its development. Strengthening a child’s capacities may involve training in the use of a wheelchair or computer or taking frequent breaks to prevent fatigue.

Giftedness also commonly goes unnoticed in children with learning disabilities. Exceptional and poor abilities can coexist in a child. In fact, an estimated 10% of gifted children have a reading problem, reading 2 or more years below grade level. Albert Einstein, Auguste Rodin, and John D. Rockefeller are famous examples of brilliant individuals who had challenges with reading and writing. An extreme example of the occurrence of extraordinary and deficient abilities together in 1 individual is the child savant. Affected children possess amazing abilities in 1 area (eg, music, drawing, mathematics, memory), but they exhibit delays in other respects. In addition, they have behavioral problems that resemble autism, such as repetitive behavior, little use of language, and social withdrawal. Learning disabilities may obscure children’s talents, thus preventing fulfillment of their potential.

Conversely, children’s giftedness may mask their weaknesses, depriving them of needed help. Worst of all, gifted children with learning disabilities may manage to barely “get by” in the regular classroom setting and fail to receive recognition for strengths or weaknesses. Large differences on intelligence and achievement tests between scores in different areas, such as language and spatial abilities, may indicate both giftedness and a learning disability. Research suggests that programs that focus on strengths, not deficits, enhance self-esteem in gifted children with learning disabilities and can be extremely beneficial in their academic development.

The identification of giftedness is also difficult in children who underachieve. Parents may approach the pediatrician with the following frustrating problem: Their child is doing poorly at school, although they believe that the child is bright because of the child’s abilities and participation in advanced activities at home. Underachievement may result from a learning disability; poor self-esteem; lack of motivation; or the absence of rewards, at home or at school, for succeeding in academics.

As previously stated, giftedness is less likely to be recognized in children from families of low income or who are ethnically diverse. For school districts that request privately obtained testing for entry into advanced educational programming, the costs may be prohibitive for some families. Additionally, many of the tests used to identify giftedness have been “normed” on white, English-speaking, middle-class children. Furthermore, studies have shown that relying on referrals from teachers who have not had additional training on recognizing giftedness are likely to result in students who do not match typical cultural perceptions of the “gifted child” being overlooked. Students who are learning English as a second language are even more likely to be overlooked for placement into advanced educational programming. For new immigrant families, there may be different sociocultural expectations of behavior in school, cross- cultural stress, or symptoms such as posttraumatic stress or depression that may mask giftedness or academic potential. Validation of newer methods of assessment that are less fraught with cultural and socioeconomic bias is ongoing. Until validated tests are available that are sensitive to socioeconomic differences, a combination of other means of identifying giftedness should be stressed, such as assessment of creative work and teacher, student, and perhaps community nominations.

Management

At Home

Loving, responsive, stimulating parenting should be encouraged for all children, including those who are gifted. Parents of gifted children may feel inadequate, fearing that their child is smarter than they are. The pediatrician can provide parental reassurance by telling parents, “You must have been doing something right for your child to have been identified as gifted.” Children’s librarians, periodicals written for parents and teachers of gifted children (eg, Gifted Child Today), and the local chapter of the National Association for Gifted Children are good resources for parents.

Parents are often overwhelmed with complex questions from their precocious preschool-age children about issues ranging from homelessness and world hunger to theology and the creation of the universe. The pediatrician should tell parents that they should not be afraid to admit that they do not know all the answers and should work together with their child to find the answers.

The pediatrician may need to warn parents about putting too much pressure on their gifted children. For example, enrolling children in multiple classes often leaves little free time for unstructured play. Play affords many opportunities for self-learning, interaction with peers, and development of creativity and initiative. Parents of infants, toddlers, and preschoolers should be encouraged to take cues from their children. If children have a rich environment with plenty of objects and books to explore, diverse experiences, and stimulating interactions, they will develop their own interests. Other educational materials and special instruction can then be provided in a particular area of interest.

Children who are gifted are often mistakenly considered to fit the stereotype of troubled, socially awkward “nerds.” With the exception of children at the genius extreme (IQ >180), gifted children are generally more sociable, well-liked, trustworthy, and emotionally stable than their peers, with lower rates of mental illness and delinquency. Nevertheless, they have the same emotional needs as other children. Gifted children may prefer to play with older children whose interests and abilities are closer to their own. This should be allowed as long as these relationships are healthy.

Parents should be encouraged to treat children who are gifted the same way they do their other children. For example, age-appropriate responsibilities and chores should be encouraged. Siblings of gifted children may become resentful if attention is centered on their gifted sibling. They may feel inferior, particularly if gifted children surpass them in school. Tensions may be magnified if gifted children become friends with their older siblings’ friends. To preserve a sense of self-worth and competence in siblings, the pediatrician should recommend to parents that they set aside special time to spend with each of their children. Parents should encourage other talents (eg, musical abilities, athletic abilities) in siblings. Older siblings should receive the special privileges and responsibilities that come with age, such as staying up later or doing different chores. Any tensions within the family should be openly discussed and addressed.

At School

Parents often seek advice from their pediatrician about educational planning for children who are gifted. A learning environment with the optimal degree of challenge—hard enough to require new learning and stave off boredom, but not so hard as to be discouraging— is the goal for all children. Parents of young children should select a preschool with a flexible program and capable teachers to accommodate children with precocious skills. Parents of school-age children must decide whether acceleration (ie, starting school earlier or skipping grades) or enrichment (ie, staying in the same grade but supplementing the regular curriculum) is more appropriate (Table 35.1). The choice of approach is dependent on the particular child.

Parents and teachers of gifted children are usually concerned that children in accelerated programs may have problems with social adjustment if their classmates are older. Existing evidence suggests, however, that children who are gifted benefit socially from acceleration. Gifted children in accelerated programs participate in school activities (except contact sports) more often than gifted children placed with classmates of the same age. Even when children who are gifted are placed with children their own age, they tend to make friends with older children with whom they share more interests. Gifted children also make up any curricular content missed by grade skipping. Because the process may be difficult to reverse, acceleration may not be the best option if doubt exists whether doing so is in the child’s best interest.

Enrichment involves keeping gifted children with same-age classmates but supplementing the regular curriculum. Regular class placement with a teacher who is willing to offer extra work (eg, special projects) in addition to grade-level assignments, part-time programs to supplement regular class work (eg, field trips, foreign language classes), honors classes that group bright children together for their basic curriculum, and independent study by the family at home are all examples of enrichment programs. These programs may work well for some children who are gifted, depending in large part on the resources and funding available and the experience, creativity, and enthusiasm of the teachers involved.

Some enrichment programs may isolate gifted from nongifted children, however, and encourage labeling of the gifted students as “elite.” If children are required to make up the regular class work that they miss when they are involved in the enrichment program, they may find themselves overloaded with homework.

Often, a combination of acceleration and enrichment programs is the best option. Acceleration or enrichment alone may be inadequate for the brightest children. Acceleration may be insufficient for markedly advanced children who would have to skip 2 or 3 grades to be appropriately challenged. The pediatrician should recommend that parents work closely with teachers to achieve the best learning environment for their children. Some factors that should be considered are age, physical size, motor coordination, emotional maturity, personality, and particular areas and degrees of giftedness of the child. Acceleration may be a better option for a physically large, outgoing child than for a small one. Gifted children should be asked what they would like to do.

When evaluating the suitability of an educational situation for their gifted child, parents should watch for certain warning signs. Excessive homework should not be expected or tolerated, because it cuts into the child’s time to play and develop socially. The emphasis in gifted education should be on broadening perspectives, not increasing busywork. If children who are gifted are developing a sense of elitism or peer animosity, the nature and philosophy of the program should be questioned. Boredom with schoolwork, not needing to study, signs of depression, or symptoms suggestive of school phobia, such as recurrent abdominal pain or headaches on school mornings, should prompt investigation into the suitability of the child’s program.

Homeschooling, either part-time to complement classroom curricula or full-time, is an educational alternative. To decide if this is the best choice for the family and the child who is gifted, parents who are considering homeschooling are advised to gather as much information as possible, including talking to other parents who are homeschooling their children, reviewing sample curricular materials, and contacting school districts and state departments about requirements and specific steps.

Schools with students from low-income or minority backgrounds tend to use their limited resources to help students who are doing poorly in school, rather than gifted students. In addition, children from low-income or minority backgrounds may experience further barriers to academic achievement, including lack of informational materials about gifted programs in parents’ native languages and difficulty meeting requirements because of parental employment responsibilities and lack of transportation. Research has shown that programs for gifted children from such backgrounds benefit all students by creating positive role models and promoting the school as a place for the cultivation of excellence. In addition to providing support for individual gifted children and their families, the pediatrician may choose to engage in an active advocacy role within the community by, for example, promoting diverse educational experiences for students of all backgrounds, helping policy makers discover and remove barriers to participation, and working with community organizations to educate families from minority or low-income backgrounds about educational opportunities for their children who are gifted.

Prognosis

Children who are gifted are a diverse group, comprising children with exceptional academic, artistic, or other abilities, combined with the creativity and commitment to achieve their potential. Children may be gifted in 1 area and average or even below average in another area. The purpose of identifying gifted children is to provide them with an educational environment to help maximize their potential. The pediatrician is poised to help children and their families recognize that other factors in addition to cognition, including social development, concepts of self-worth, self-discipline, and resilience, are also vitally important to the overall success and well-being of the child. Pediatricians can serve as a resource for parents in raising children who are gifted and helping children and families obtain appropriate evaluation, educational programs, and supportive resources. The prognosis for gifted children is excellent.

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