Why It's Hard for Twice Exceptional ADHDers to Get Support

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ADHDers can be exceptional humans. They often have a lot of creativity, curiosity, and strong problem-solving skills. This is why they tend to make successful entrepreneurs. They sometimes also have twice exceptionality.

“Twice exceptional” is a term coined by the international leader in special education and gifted and talented education, James J. Gallagher. The word “exceptional” is typically used in special education to identify exceptional strengths and talents, which enable a student to be classified as “gifted” or have exceptional deficits.

The Elementary and Secondary Education Act (ESEA) offers the following definition of gifted and talented students:

“Students, children, or youth who give evidence of high achievement capability in areas such as intellectual, creative, artistic, or leadership capacity, or in specific academic fields, and who need services and activities not ordinarily provided by the school in order to fully develop those capabilities. Exceptional deficits or disabilities may include specific learning disabilities (SLD), speech and language disorders, emotional/behavioral disorders, physical disabilities, autism spectrum disorder, or other impairments such as attention deficit hyperactivity disorder (ADHD).”

“Twice-exceptional,” also referred to as “2e,” is the term used to describe learners that fit into both groups simultaneously. Gifted students can have a co-existing disability or disorder, and students with a disability can also have high cognition or a high IQ. Having one does not preclude the possibility of having the other. There’s solid scientific evidence to support the findings.

This also speaks to the significance of embracing a neurodiversity framework. which argues that it’s time to break away from an outdated and unhelpful paradigm and recognize that the two are not mutually exclusive. One does not, and has never, limited the other from being possible.

Sounds somewhat straightforward, right? Not quite. Sadly, a diagnosis of “twice-exceptional” is needlessly controversial and invalidated by some educators and school systems. Consequently, many gifted ADHDers will not receive educational services to nurture their exceptional ability and accommodate their disability. Qualifying for special education instruction as a student with ADHD to ensure equality in schooling is unreasonably difficult in many experiences. Being a “gifted” student with ADHD and obtaining special education services is seemingly impossible for countless youths.

As of today, only 29 states mandate gifted programming. These young people are some of the citizens with the budding potential to generate instrumental and unique solutions to many of the world’s current and future issues. I believe that this is a social tragedy and a disservice to the country and our collective futures, especially when our nation’s creative productivity has been challenged annually for decades.

Why It Can Be Hard Get Support for a 2E Child

1. Lack of training about ADHD and high cognition in school systems.

There are many harmful myths and misconceptions about ADHD and high cognition in school systems. Rebecca Jacobs, Esq., published an article in the Children Rights Journal in 2020 that describes the issue perfectly:

“A large percentage of students who have been deemed twice exceptional will not receive the needed services because once they are found to qualify for one exceptionality, they will likely not be tested for the other. Twice-exceptional students caught in between are often labeled as ‘lazy’ and ‘unmotivated’ because their giftedness can mask their special needs and vice versa.

“When the parents have inquired as to whether these difficulties of their offspring might be due to an attention deficit disorder, many have been told that such problems do not occur among individuals with such high levels of intellectual ability.”

This is simply untrue. High-IQ children can fully meet the diagnostic criteria for ADHD. A 2007 study sought to investigate the results of the Massachusetts General Hospital Longitudinal Family Studies of ADHD to evaluate whether ADHD was an accurate diagnosis in the presence of high IQ. Their analysis found that ADHD was a valid diagnosis among high-IQ children.

Three years later, in 2010, researchers conducted a case series empirical study to investigate further the controversy and validity of an ADHD diagnosis in children who also demonstrated a high IQ. Their data also supported that ADHD is a valid diagnosis in children with high IQs. A landmark NIH study, conducted in 2012, also found no association between IQ and ADHD, noting that “Lower IQ does not seem to be a general explanation for the impairments in these specific cognitive domains.” Yet the myth that ADHD is linked to low IQ persists.

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According to the National Association for Gifted Children (NAGC), early identification improves the likelihood that “gifts” will be developed into “talents.” What happens to the nation’s untapped talent without widespread training amongst school staff?

2. Federal law.

The National Association of Education (NEA) states that Federal law does not require that states and districts provide for the educational needs of gifted and talented learners. As a result, gifted programming decisions in the United States are made at the state and local levels.

This does not mean that the federal government does not recognize “2e” students. Indeed, students are protected under the Individuals with Disabilities Education Act (IDEA) and its implementing regulations. In a 2013 letter addressing a Professor of Education and his inquiry about “2e” students, the United States Department of Education, Office of Special Education and Rehabilitative Services stated the following:

"The IDEA does not specifically address 'twice exceptional' or '2E' students. It remains the Department's position that students who have high cognition, have disabilities, and require special education and related services are protected under the IDEA and its implementing regulations… That is, under 34 CFR §300.8, a child must meet a two-prong test to be considered an eligible child with a disability: (1) have one of the specified impairments (disabilities); and (2) because of the impairment, need special education and related services…. In the Analysis of Comments and Changes in the 2006 final regulations implementing Part B of the IDEA, the Department, in responding to public comments, recognized that there will be some students who are gifted but also need special education and related services." See 71 Fed. Reg. 46540, 46647 (Aug. 14, 2006)

As such, parents and therapists must note this statement by Rebecca Jacobs, Esq.: “Per IDEA, a state may not use a twice-exceptional student’s high academic scores as the reason to deny them eligibility for special education.”

3. Definition confusion, cut-off scores, single test use, or relying on IQ scores alone.

• Definition: There is currently no universally adopted definition or profile of a “gifted student.”
• Cut-off scores for “gifted”: Identification policies and procedures are determined at the district level. IQ scores for the U.S. population are based on a bell-shaped curve, meaning that the average IQ in the US is 98, with the majority of people falling between 85 and 115. Many schools require a student to score 130 on an intelligence test to be classified as “gifted.” Are the 116-129 students of “average” intelligence with this classification system?
• Use of one test: According to NAGC, testing to assess “gifted” status is intended to be a multi-phased and multi-rater evaluation process. If one test is utilized to determine eligibility, it is safe to question the determination.
• Relying on IQ scores alone: IQ tests have been notoriously controversial metrics of “intelligence” and “talent.” Relying on IQ or performance results alone may overlook students who excel in one area and still qualify as “gifted.”

4. Funding.

Unfortunately, many schools do not receive the funding to create programming for the gifted and talented. Even relatively progressive and wealthy states, like New York, can fail to mandate gifted education services. It’s not always for lack of trying. New York State Senator Joseph P. Addabbo Jr. introduced a bill in 2013 requiring teachers in New York to obtain training about twice exceptionality and programming for twice exceptional students. Unfortunately, it has yet to be passed.

5. High IQ can “mask” ADHD symptoms.

One of the hallmarks of an ADHD diagnosis is having a deficit in executive functioning, such as problems with working memory, auditory verbal working memory, processing speed, managing time, and keeping organized. It’s been found that ADHD individuals with a high IQ can manage their symptoms better than ADHD individuals with lower IQs. A 2017 study found that adults with an ADHD diagnosis with a higher IQ exhibited less dysfunction with executive functioning deficits than those diagnosed with ADHD and an average IQ. The researchers purport that this compensatory mechanism “leads to problems establishing a precise clinical diagnosis.”

Why It Matters

The National Education Association states that at least 6-7 percent of all students are “2e.” More than 3 million out of the estimated 50 million students nationally per a 2019 consensus. If those students aren't supported, that conceivably equates to millions of world-changing ideas discarded, rejected, and lost forever.

In Gallagher’s words, “… failure to help the gifted child reach his potential is a societal tragedy, the extent of which is difficult to measure but what is surely great. How can we measure the sonata unwritten, the curative drug undiscovered, the absence of political insight? They are the difference between what we are and what we could be as a society.”