Children who are gifted: Characteristics and identification

INTRODUCTION — Individuals who are gifted have exceptional abilities in a particular domain or domains.

This topic review will discuss the terminology, characteristics, and identification of children who are gifted. Educational interventions and primary care management are discussed separately. (See "Children who are gifted: Educational interventions and primary care management".)

TERMINOLOGY

●Giftedness – Individuals who are gifted have exceptional abilities in a particular domain or domains (eg, mathematics, music, athletics). In addition, they typically have high degrees of self-motivation, curiosity, perseverance, and enjoyment in developing and expressing their talents [1].

There is no universally accepted definition for giftedness, which can manifest in a variety of ways [2]. However, there is broad consensus that giftedness cannot be defined solely by an intelligence quotient (IQ) score on a standardized test [1,3]. IQ scores do not take into account creativity and practical intelligence.

Other terms that are used to describe giftedness include "outstanding talent," "gifted and talented," and "high-ability." (See 'Presentation and characteristics' below and 'Identification' below.)

The United States Department of Education (DOE) definition for giftedness is widely accepted by researchers and practitioners in the field of giftedness (table 1) [4]. The DOE definition is similar to that provided by the National Association for Gifted Children [5]. In the United States, most state boards of education provide definitions for gifted/giftedness, but the definitions may differ from the United States DOE definition [6]. The definitions used by individual states are available from the National Association for Gifted Children.

●Gifts versus talents – "Gifts" and "talents" are two terms central to the discussion of giftedness. Some debate persists about the distinction between the terms. For the purpose of this topic review, we will use the following definitions [7]:

•Gifts – Gifts are the skills or abilities that are innate to the individual. Giftedness does not become manifest unless the gift is developed.

•Talent – Talent is what the individual develops out of their gifts. Talents are the result of learning and experience. In this topic review, we use the term "high ability" interchangeably with "talent."

●Intellectual giftedness – Intellectual giftedness (sometimes called "school-house giftedness") refers to giftedness in cognitive abilities and academics (eg, language, abstract logical thinking, mathematics).

●Nonintellectual giftedness – Nonintellectual giftedness refers to giftedness in nonintellectual domains (eg, music, art, dance, leadership).

●"Twice-exceptional" – Twice-exceptional is the term used by practitioners in the field of giftedness to describe children with giftedness and coexistent neurodevelopmental or psychiatric conditions (eg, giftedness and learning disorder) [8,9]. Alternatively, the term "twice exceptional" can refer to students who are gifted or talented and who also qualify for one or more of the special education categories defined by the Individual with Disabilities Education Act [10].

PRESENTATION AND CHARACTERISTICS — The caregiver of a child who is gifted may present to the primary care clinician describing characteristics associated with giftedness (table 2) [11-15]. Children who are gifted typically have high degrees of self-motivation, curiosity, perseverance, and enjoyment in developing and expressing their talents [1].

Children with giftedness also may present with problems at school, such as inattention, behaviors that interfere with classroom functioning, or underachievement [16]. Children who are gifted may underachieve at school for a variety of reasons (eg, fear of failure, desire to fit in with peers, anti-intellectual school atmosphere, poor study habits, coexisting learning disorder, and frustration due to boredom) [13,17,18].

Developmental characteristics

●Advanced domain-general skills and capacity for learning rapidly – Children who are gifted may have obviously advanced skills in language, reasoning, or humor (table 2). They may develop their skills quickly and be able to rapidly and intuitively understand concepts or make connections between one concept and another. Young children may have conversational skills and interests more commonly seen in older children and may prefer the company of older children. Older children may acquire academic skills quickly and complain of boredom at school.

●Developmental asynchrony – Children who are gifted may be very advanced in some areas but have average or below average skills in others. Caregivers may state, for example, that the child has highly advanced mechanical skills, math skills, or reasoning skills, but age-appropriate or even delayed handwriting or reading skills.

Children who are gifted also may have different rates of intellectual, social, and emotional development [19]. As an example, a four-year-old child may have the intellectual skills (eg, thinking, writing, mathematical) of an eight-year-old but age-appropriate social and emotional development [13]. Developmental asynchrony may lead to difficulty finding playmates. It may also result in adults' expectations of behavioral or social maturity that are beyond the child's capacity. Both of these situations can lead to frustration and experiences of disappointment.

The series of writing samples from a child in a gifted kindergarten class (figure 1A-D) demonstrates some of these characteristics:

•Advanced skills – The student's advanced writing skills are present before kindergarten. The sample from the beginning of the year (figure 1A) reveals writing skills that would be common in late kindergarten or early grade 1.

•Rapid pace of learning – The rate of improvement in this series of writing samples far surpasses what would be expected of a typical kindergarten student. The final writing sample (figure 1D) is much more sophisticated in text and word complexity than the initial writing sample; it is more characteristic of a grade 3 (ie, eight- to nine-year-old) student than a student finishing kindergarten. However, spelling skills are more characteristic of a grade 2 (ie, seven- to eight-year-old) student.

•Handwriting skills – This student's handwriting skills improve over the course of the year. However, some students who are gifted may not have the same rate of improvement in handwriting skills as they do in cognitive skills, resulting in developmental asynchrony.

•Drawing skills – The student's drawing skills are age-appropriate and are not advanced.

Emotional characteristics — Children who are gifted generally have good emotional adjustment [20]. In observational studies, children with intellectual giftedness in the moderate range (intelligence quotient [IQ] between 130 and 144) typically have slightly lower rates of emotional difficulty than those in the general population [21-23]. In one systematic review, the overall rate of psychopathology in children who are gifted was not above the expected level for the population as a whole [24]. However, the rate of social-emotional problems among children with profound giftedness (ie, those with intelligence quotient >160) is approximately twice as high as in the general population [21-23]. The social and emotional adjustment problems of students with profound giftedness appear to be related to difficulty finding a peer group and appropriate academic stimulation.

Although children who are gifted generally are well adjusted emotionally, they have particular areas of emotional vulnerability, including [13,16,25,26]:

●They may be extremely perfectionistic and have difficulty accepting failure. This can lead to anxiety and avoidance behaviors. Perfectionism can be debilitating, especially if the child is excessively self-critical and unable to celebrate their accomplishments or is motivated by fear of failure or the desire to please others.

●They may experience their emotions strongly and react to situations that are unnoticed or evoke only mild reactions in age-matched peers (eg, an eight- or nine-year-old child who is saddened by world poverty). They may be more sensitive to criticism and injustice than age-matched peers.

●They may be moody, explosive, argumentative, or defiant when they cannot reach their goal or when they cannot continue to pursue their area of interest. They may become depressed by their limited ability to attain what others perceive as overly idealistic goals.

●They may become frustrated by the inconsistent behavior of others.

●They may be socially isolated, feeling "different" than other children and believing that age-matched peers think differently and about different things than those that interest them; students with profound giftedness are at the greatest risk of social isolation because of the extreme asynchrony between their intellectual development and their emotional and social development.

Social characteristics — Social characteristics of children who are gifted may include [11-15,17]:

●Tendency to be solitary and introverted; they enjoy playing on their own and pursuing their own interests

●Lack of interest in socializing with peers of the same age; may seek out older peers with whom to socialize

●Highly focused on their own agenda and goals; may be considered "narcissistic"

●Greatly concerned with moral and philosophical questions (eg, becoming easily upset when faced with injustice, such as in peer-peer interactions, adult-child interactions, or when learning about injustices that occur in the world at large)

Behavioral characteristics — Behavioral characteristics of children who are gifted may include [11-15]:

●Disorganization or inattentiveness (partly because they are preoccupied by their area of interest)

●Constantly asking questions about their area of interest

●Overly focusing on their area of expertise (to the point of preferring solitary activities to socializing)

●Fierce independence and nonconforming

●Interest in experimenting and doing things differently or putting ideas or things together in ways that are unusual or creative; this behavior is not always valued in the home or classroom setting

●Intense bursts of effort/work for one or several hours, followed by a period of not being able to engage in that activity at all and being tired and listless

COEXISTING CONDITIONS AND DIFFERENTIAL DIAGNOSIS — Students who are gifted may have coexisting conditions such as learning disorder (LD), attention deficit hyperactivity disorder (ADHD) or other behavior disorders, autism spectrum disorder (ASD), anxiety, or depression [15]. In such cases, it can be difficult to identify both the giftedness and the coexisting condition – giftedness can be "masked" or overshadowed by the other condition and vice versa [27,28]. Children with coexisting giftedness and other neurodevelopmental conditions may be referred to as "twice exceptional." (See 'Terminology' above.)

It is important to differentiate between giftedness that is associated with interfering behaviors or emotions (eg, inattention due to over-focus on personal interests or anxiety due to concerns about social injustice) and giftedness that is associated with a coexisting psychiatric condition or a developmental disability (eg, ADHD, anxiety) that may require clinical services. Professional evaluation, including comprehensive psychological or neuropsychological evaluation, may be necessary for accurate diagnosis [9,29]. (See 'Identification' below and "Children who are gifted: Educational interventions and primary care management".)

Learning disorder — Students who are gifted can have a coexistent LD. The developmental asynchrony between the student's strengths and weakness may need to be quite marked for both conditions to be identified. In some cases, a caregiver or teacher may focus on delays or difficulties in one area (eg, handwriting, phonemic awareness) and overlook indications of giftedness in other areas (eg, mathematics) [8]. In other cases, caregivers or teachers may overlook learning difficulties in a child who is gifted because they assume that the child's giftedness will compensate for the difficulties [30].

If the LD is not detected and/or addressed, the student who is gifted may be discouraged by lack of achievement or lower achievement in the area of weakness [13]. They may lose confidence and enthusiasm for school and become frustrated with academics [31].

Use of a standardized assessment to identify a coexisting LD should compare the student's performance with their intellectual potential, not to the performance of same-age or same-grade peers [32]. Identification practices for LD in students who are gifted vary widely. In one synthesis of quantitative research on LD in students who are gifted, the authors highlight inconsistencies in case identification for both giftedness and LD [33]. These inconsistencies make it difficult to draw firm conclusions about the incidence of giftedness and coexistent LD. Identification procedures may use formal cognitive measures, data gathered through a "Response to Intervention" model [34], or qualitative review of the student's academic performance. (See "Specific learning disorders in children: Clinical features" and "Specific learning disorders in children: Evaluation", section on 'Comprehensive evaluation'.)

Educational interventions and strategies for students who are gifted and also have a LD are discussed separately. (See "Children who are gifted: Educational interventions and primary care management", section on 'Gifted with learning disorder' and "Specific learning disorders in children: Educational management".)

Attention deficit hyperactivity disorder — Students who are gifted can have coexistent ADHD (ie, intrinsic difficulty regulating attention) [13]. However, they also may appear to be inattentive or disorganized because they are bored or preoccupied with their area of interest. (See "Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis", section on 'Clinical features'.)

It is important to determine whether symptoms of inattention in a child who is gifted are a manifestation of their giftedness or coexisting ADHD. Children with coexistent ADHD may require treatment with medication and/or behavioral therapies in addition to the educational interventions and strategies for giftedness. In contrast, inattention due to boredom or preoccupation with an area of interest is treated by offering an appropriate level of stimulation.

Whereas inattention due to boredom is purposeful and is recognized by the student if they are asked for an explanation, most students with ADHD are not able to explain their inattention [35]. In addition, the symptoms of inattention and/or hyperactivity in ADHD must occur in more than one setting and affect the student's ability to function at school, home, or in community activities. (See "Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis", section on 'Diagnosis'.)

When students who are gifted are provided with an appropriate level of stimulation, inattention and other inappropriate behaviors may diminish. However, most children with ADHD require behavioral and/or medical treatments to circumvent their inattention. (See "Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis", section on 'Overview of management'.)

Behavior disorders — Although interfering behaviors and being argumentative with adults may be an expression of giftedness, students may exhibit disruptive or oppositional behaviors that are outside of their control and meet criteria for a disruptive behavior disorder.

Intrinsic difficulty with self-regulation must be distinguished from challenging behaviors related to giftedness. These behaviors may include: creativity in how they explore their interests or solve problems; incessant questions; frustration or anxiety when not permitted to pursue their interests or when their performance does not live up to their perfectionistic standards; or a desire to always prove themselves to be right.

The diagnostician and/or therapist who works with children who are gifted should understand aspects of giftedness that can mimic psychiatric conditions such as "narcissism." To meet criteria for a behavior disorder, the behavior problems must be frequent, severe, and pervasive.

Autism spectrum disorder — Students who are gifted can have a coexisting ASD [28]. However, the over-focus on preferred interests and the social isolation that can ensue in children who are gifted also can be mistaken for an ASD.

It is important to differentiate between ASD, features of giftedness that mimic ASD, and coexistent giftedness and ASD so that appropriate services can be provided. In contrast to individuals with ASD, most students who are gifted are able to explain why they choose to pursue certain interests and why they may choose to limit their social interactions. The intense interests of children who are gifted are functional, varied, and can lead to a vocation. In addition, most students who are gifted enjoy social interactions, although they may be selective about the peers with whom they socialize.

A true lack of interest in social activities, or over-focus on an excessively narrow range of interests, may be more compatible with an ASD. In children with ASD, the severity of social impairment results in functional impairments at school, home, or in the community. (See "Autism spectrum disorder in children and adolescents: Clinical features" and "Autism spectrum disorder in children and adolescents: Evaluation and diagnosis", section on 'Diagnostic criteria'.)

The identification of coexistent giftedness and ASD may require referral for comprehensive neurodevelopmental, psychological, or neuropsychological evaluation by a developmental-behavioral pediatrician, a child psychiatrist, or neuropsychologist who can identify both the giftedness and ASD [28,29]. This is complicated by a lack of consistent case definition in research [36]. In contrast to students who are gifted without a coexisting condition, those with coexistent ASD may [28]:

●Have a pedantic and seamless speech pattern

●Have a need for routine and little tolerance for change

●Not understand ambiguity in humor or sarcasm

●Not understand nonliteral meanings in language

●Have an inappropriate affect

●Lack insight regarding social relationships and emotions

●Have motor clumsiness and/or stereotypic motor mannerisms

Anxiety or depression — Students who are gifted can have anxiety or depression related to understimulation of their giftedness, lack of social stimulation, or as a coexistent condition. (See "Pediatric unipolar depression: Epidemiology, clinical features, assessment, and diagnosis".)

IDENTIFICATION — Giftedness usually is formally identified by neuropsychologists, school psychologists, or experts in the child's area of talent. The way in which giftedness is identified may vary depending upon the circumstances [2]. Formal identification of giftedness may be important to determine eligibility for certain education programs, services, or special consideration.

The identification of giftedness is to some extent culturally determined. The recognition of intelligence, academic success, and talents in nonacademic domains depends upon what types of skills are valued in a given community and what types of skills are valued or fostered by the family. Because these values are different in different communities and cultures, children from certain cultural or linguistic backgrounds may be underrepresented in programs for academic giftedness, particularly if it is identified by intelligence quotient (IQ) score alone [37]. (See 'Pitfalls in identification' below.)

Identification of children and adolescents who are gifted in underserved communities remains a challenge. Potential approaches to improve identification of students in these communities include:

●Comparison of the student's performance against building or school district norms rather than national student norms

●Use of local performance measures for intellectual giftedness rather than standardized measures

●Use of a standardized screening process to identify students who are underchallenged or gifted rather than reliance on a teacher-referral process

These approaches combined with adequate resources for teachers who have struggling or underchallenged learners may help reduce institutional bias (ie, against students coming from less privileged backgrounds). However, implementation of these approaches will remain a challenge as long as broader societal inequities persist [38].

Similarly, nonacademic giftedness (eg, in athletics, leadership, music, or the arts) also may not be identified, depending upon the values and cultural norms of the child's family. Finally, identification procedures can vary according to the cultural norms of the evaluator. Some researchers and practitioners in the field favor a developmental model of giftedness, which states that giftedness can unfold over time and is not a static phenomenon [39].

Intellectual giftedness — Neither the United States Department of Education definition of giftedness/high ability nor other definitions of giftedness provide specific guidance for identification of intellectual giftedness (table 1).

Intellectual giftedness generally is identified through a combination of intelligence testing and qualitative measures [29]. In the final determination, the informed judgment of educators and psychologists is more important than strict cut-off scores. The reliability and validity of identification is increased by including multiple measures, criteria, and sources of information [3].

Intelligence quotient — Multiple measures are needed to successfully identify intellectual giftedness [3]. However, the IQ is a central feature of most identification practices. Verbal, analytic, and logical thinking skills, which are measured by intelligence testing, are necessary for intellectual giftedness, but they are not the only skills needed for academic success. Measures of creativity and practical intelligence have been created, but their reliability and validity are not yet documented [40].

Different cut-off IQ scores are used to identify giftedness in different circumstances. Historically, the 98^th percentile (an IQ score of 130 or higher) is used as part of the definition of intellectual giftedness [41]. A more nuanced set of definitions is based upon different ranges of IQ scores. As an example [42]:

●Mildly gifted – Full scale IQ 115 to 129 (top 13.6 percent); the capacity for learning, social qualities, or other areas of talent may be used to identify a student with IQ in this range as gifted

●Moderately gifted – Full scale IQ 130 to 144 (top 2.1 percent)

●Highly gifted IQ – Full scale IQ 145 to 159 (top 0.13 percent)

●Intelligence measures can be inaccurate when the IQ score is >160; children with IQ in this range are described as exceptionally or profoundly gifted (top 0.003 percent and beyond)

A definition based on IQ score alone is reliable (ie, repeated measurements fall closely together) but subject to limitations [41,43,44]:

●Relying exclusively on IQ score may fail to identify students who are gifted because of measurement error, underrepresented cultural or linguistic status, or poor performance by the student on the day of the test

●IQ scores are not appropriate for use in some populations (eg, children from sociolinguistic backgrounds different than those of the children on whom the test was standardized, young children, children with learning disabilities)

●Some IQ measures have upper boundaries that limit their usefulness in the identification of giftedness (ie, >130)

Children with language impairment or children from culturally and linguistically diverse families whose heritage language is not the same as the language of instruction at school may be identified more successfully using nonverbal measures of intelligence [45]. Other limitations of psychometric measures are discussed in greater detail separately. (See "Specific learning disorders in children: Evaluation", section on 'Limitations of psychometric measures'.)

Despite their limitations, standardized tests of intelligence can be helpful when there are specific issues to address (eg, eligibility for early school entry or entry into a special program; helping to determine whether boredom or misbehavior in the classroom is due to understimulation or learning disorder) [13]. (See 'Coexisting conditions and differential diagnosis' above.)

Qualitative measures — Qualitative measures that can be used in the identification of giftedness include the student's educational history, work samples, report cards, portfolios, teacher nominations, and peer nominations [3].

Pitfalls in identification — Pitfalls in the identification of giftedness may include the following: [8,12,13,16,46]:

●Some children may not be willing to display their abilities in front of clinicians or teachers, whether because of cultural differences and what is considered to be appropriate behavior towards adults, or because of peer pressure, etc.

●Language barriers may mask curiosity or may limit the student's capacity to express what they know.

●Adults may attribute characteristics of giftedness to other conditions (eg, inattentiveness may be attributed to attention deficit hyperactivity disorder rather than to boredom from understimulation; questioning the teacher or caregiver may be attributed to oppositional defiant disorder rather than to curiosity). (See 'Coexisting conditions and differential diagnosis' above.)

●The gift is masked by a learning disorder (decreased performance in the weak area may lower the overall IQ score). (See 'Coexisting conditions and differential diagnosis' above.)

●Giftedness may be overshadowed by a psychiatric condition (eg, depression or anxiety).

●Adults may not recognize underachievement as a clue to giftedness (eg, if the student is bored, has low self-esteem, or a fear of failure).

●The child may "hide" their intellectual ability to appear more like their peers.

Nonintellectual giftedness — Giftedness in nonacademic domains (eg, music, art, athletics, leadership) is usually identified by experts in the field, review of work samples, and performance history [40]. Psychometrically sound instruments to assess nonacademic giftedness are lacking.

ROLE OF THE PRIMARY CARE PROVIDER — The primary care provider may play a role in identifying giftedness and coexisting conditions and providing anticipatory guidance and support to families with a child who is gifted [29]. This section will focus on the role of the primary care provider in identification of giftedness and coexisting conditions. The supportive role of the primary care provider is discussed separately. (See "Children who are gifted: Educational interventions and primary care management", section on 'Role of the primary care provider'.)

The primary care provider may identify potential giftedness in early development through routine developmental surveillance [13,29]. Advanced verbal skills are easiest to identify; other clues to advanced abilities may include self-directed interests in projects or increased depth and breadth in an academic or nonacademic domain, as compared with similarly aged children (table 2) [13].

In the school-aged child, the primary care provider may recognize giftedness as a possible cause of underachievement, inattention, behavior disturbances, or atypical social behaviors [29]. (See 'Coexisting conditions and differential diagnosis' above.)

Once potential giftedness is identified, the primary care provider can help with referrals for more definitive evaluation (ie, comprehensive psychoeducational or neuropsychological evaluation) [13,29]. When making such referrals, it is important to ensure that the tester has experience with children who are gifted. (See 'Intellectual giftedness' above.)

RESOURCES — Resources for clinicians and families are provided in the table (table 3).

SUMMARY

●Terminology – Individuals who are gifted have exceptional abilities in a particular domain or domains (eg, mathematics, music, athletics). There is no universally accepted definition for giftedness. However, the United States Department of Education definition for giftedness (table 1) is widely accepted by researchers and practitioners in the field of giftedness. (See 'Terminology' above.)

●Presentation and characteristics – The caregiver(s) of a child who is gifted may present to the primary care clinician describing characteristics associated with giftedness (table 2). Children who are gifted also may present with problems at school that the caregiver attributes to being insufficiently challenged (eg, boredom, inattention, distracting other students, underachievement). (See 'Presentation and characteristics' above.)

Children who are gifted may be very advanced in some areas but have average or below-average skills in others. They generally have good emotional adjustment, but they have particular areas of emotional vulnerability (eg, perfectionism, intense emotions, social isolation). They tend to be introverted and enjoy playing on their own. They can be highly focused on their own areas of interest. (See 'Presentation and characteristics' above.)

●Coexisting conditions and differential diagnosis – Students who are gifted may have coexisting conditions, such as learning disorder, attention deficit hyperactivity disorder (ADHD) or other behavior disorders, autism spectrum disorder, anxiety, or depression. In such cases, it can be difficult to identify both the giftedness and the coexisting condition. Children who are gifted also may have symptoms of these conditions that are a manifestation of their giftedness (eg, inattention due to boredom or preoccupation with an area of interest rather than ADHD). Professional evaluation, including comprehensive psychological or neuropsychological evaluation, may be necessary for accurate diagnosis. (See 'Coexisting conditions and differential diagnosis' above.)

●Identification – Giftedness usually is formally identified by neuropsychologists, school psychologists, or experts in the child's area of talent. Intellectual giftedness generally is identified through a combination of intelligence testing and qualitative measures (eg, educational history, work samples, report cards, portfolios, etc). (See 'Identification' above.)

●Role of the primary care provider – The primary care provider may identify potential giftedness through routine developmental surveillance (table 2) or by recognizing giftedness as a possible cause of underachievement, inattention, behavior disturbances, or atypical social behaviors. Once potential giftedness is recognized, the primary care provider can make referrals for formal identification (eg, to a neuropsychologist, school psychologist) or for evaluation and management of a coexisting condition. (See 'Role of the primary care provider' above.)