Psychological Services

ADD Often Goes Undetected in Bright Children

Bright children have historically been seen as using higher levels of cognitive reserve or ability to compensate for ADD symptoms.

ADD symptoms remain hidden beneath the child’s ability to compensate. On neuropsychological testing, scores tend to regress to the mean or average limits as higher level abilities are used to compensate for deficit areas. The result is that the whole picture remains depressed and deceiving. No one sees how smart the child is or how significant the deficits are. No one understands why he or she would be so frustrated with school. They are typically labeled as “lazy,” seen as not caring about school and “not trying their hardest” to achieve. These are the children who tend to become so frustrated, anxious or depressed that they give up. The child assumes they are not smart; the parent or teacher assumes that the child does not care.

In this scenario, it becomes easier for the child to avoid school and avoid conflict with parents or teachers by lying about their work and maintaining an outward appearance of not caring about school. Unfortunately, despite their outward façade of ambivalence these children do care and are internally highly frustrated and angry, thus making intervention by a professional a rather difficult endeavor. By the time of adolescence, these children scoff at the professional who tells them they are smart because they have stopped believing in themselves. Social or sports activities take precedence. Former goals regarding school achievement are forgotten.

These are the children who in compensating for ADD symptoms over time tend to show the more significant gap or decline in their spatial functioning. The gap is representative of more extreme degrees of compensation given their abilities and higher levels of cognitive reserve. It is not uncommon to see a well below average vocabulary or reading problems (rate, speed or comprehension) in the bright population diagnosed with a genetic attention disorder. The bright population is what we refer to affectionately as “the sleepers;” those individuals who do not come to the attention of their teachers due to their ability to compensate, or to “get by” and still attain average grades.

Intervention is more difficult when the above cyclical, emotional issues are in place at the time of diagnosis. This is the population who could not be reached before we began our cognitive therapy intervention program at this facility. However, currently these are the children who make the most dramatic leap following completion of the IM(Interactive Metronome) program given the improvement in brain functioning (seen on post-evaluation) and the simultaneous benefit to their emotional state, decreased anxiety and depression symptoms.

Following completion of the training program we want these children to develop good study habits and make use of the changes in their brain so they begin to immediately use their newfound assets and lock in the upward line of success. We have a tutorial program consisting of six hours to teach junior high and high schoolers good study habits and skills.

To summarize; in bright children:

The problem can be more emotional, involving a disbelief in academic prowess, a pessimistic attitude about school, and the procrastination and avoidance that naturally follows these thoughts. Different temperament styles and personality traits, especially involving locus of control (internal versus external) will have an additional effect on the system described above, (whether the person easily gives up on reading or compensates by memorizing their words and continually working hard to read fluently). Finally, grade level, family stressors and developmental stages results in different symptom manifestations.