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Pediatric Therapy Corner: Meeting The Social and Emotional Needs of Gifted and Twice Exceptional Children through Pediatric Therapies

by Debra Johnson, MS, OTR/L
Children referred for occupational and speech therapies, whether in private or school based settings, typically present with a wide range of social and emotional needs related to cognitive and physical disabilities, speech-language delays that impact social skills, functional impairments that limit social and play skills, and difficulty with meeting the demands of developmental challenges.  Gifted and twice exceptional children (defined as gifted with a disability) present with a unique set of social and emotional needs that requires adaptation in therapeutic approaches and therapist knowledge of issues specific to the gifted population.
Giftedness is typically defined by advanced intellectual functioning and most often identified by standardized IQ testing.  Recently the National Association for Gifted Children (NAGC) revised its definition of giftedness by referring to advanced levels of aptitude or competence in the top 10% or rarer.  Children who are identified as gifted are noted to have high potential for talent development in one or more domain such as mathematics, language, athletics, music or art.   While definitions of giftedness may vary, most professional recognize that gifted children often possess a cluster of characteristics that may include:

  • Emotional sensitivity and intensity
  • Moral intensity
  • High degree of compassion
  • Highly imaginative and creative
  • Perfectionism
  • Tendency to question authority
  • Overly concerned with justice, fairness
  • Perseverant and highly focused on specific areas of interest
  • High levels of energy or activity
  • Preference for older companions, adult interaction
  • Heightened awareness, keen observation skills
  • Strong curiosity, desire for knowledge

In 1991, The Columbus Group (a gathering of professionals and parents invested in furthering understanding and services for gifted children and adults) formed the following definition of giftedness:
“Giftedness is asynchronous development in which advanced cognitive abilities and heightened intensity combine to create inner experiences and awareness that are qualitatively different from the norm. This asynchrony increases with higher intellectual capacity. The uniqueness of the gifted renders them particularly vulnerable and requires modifications in parenting, teaching and counseling in order for them to develop optimally.”

Asynchronous development is characterized by disparities between various areas of development.  For example, an 8 year old gifted child may have the cognitive abilities of a 14 year old, the gross motor skills of a 10 year old and the fine motor skills of a 6 year old. There can also be asynchronies involving advanced awareness of social issues and heightened moral reasoning but emotional coping strategies that fall at or below chronological age level.  Asynchronous development is often greatest in the twice exceptional child who may have profoundly advanced skills in one area but lag far behind in other areas related to a specific disability.  The twice exceptional child (also referred to as “2E”) is most frequently mislabeled due to the disability masking the giftedness or the giftedness masking the disability.

This combination of unique characteristics and asynchronous development lead to a set of emotional and social needs that are often misunderstood and not addressed for the gifted child.  Whether the child is being seen by an occupational, physical or speech therapist, understanding these needs and including them in both the assessment and treatment plan will help to improve functional outcomes for these children in therapy.  If the child has already been identified as gifted, the therapist should consider this when developing the treatment plan and adjust both the assessment and interventions accordingly.  If the child has not been identified, the therapist knowledgeable in gifted issues may serve as a catalyst for appropriate identification and referral to other services in order to meet the child’s needs.

Just as a therapist may need to adapt assessment procedures for a child who, by nature of the disability, is unable to follow instructions for standardized assessments, so must the therapist accommodate the needs of gifted children during the initial evaluation.  Using knowledge of gifted characteristics and asynchronous development will help the therapist adapt approaches for testing and improve accurate assessment of the child.  In my own experience, I have had to adapt testing to accommodate for gifted 4 year olds who experienced a sense of embarrassment at completing tasks that were difficult or new to them.  These children sometimes avoid tasks not so much because they cannot do them but because of the intense feelings of self-consciousness they experience with people watching them; a feeling not expected in a typical 4 year old.   Older gifted children are often able to demonstrate learned skills for gross motor activities despite having an underlying motor dyspraxia.  These children are so adept at “top-down” cognitive processing and observation while being highly motivated to meet task demands in peer settings.  They may exert a tremendous of cognitive effort and practice to learn skipping, for example, and then task performance on an assessment may mask the underlying dyspraxia.  Being able to tease this out is critical in assessment so as to identify the true area of need in terms of functional skill performance that may be producing stress and anxiety for the child.

Treatment approaches also need to be adapted when working with gifted children.  While many children with disabilities may display a need for increased control of their surroundings, gifted children often display this as a characteristic of their giftedness, related to need for knowledge and specific learning style of self-discovery or “hands on” learning. For example, a gifted 5 year old may have a strong desire to investigate a new piece of equipment presented during a therapy session before actually using it.  The child may be compelled to explore the item thoroughly and in ways the therapist did not anticipate prior to being able to follow directions for the structured task.  This may include taking the item apart (if possible), asking many questions about the item, using or manipulating the equipment in various ways and putting it together with other objects.  This behavior is not necessarily to be considered problematic as it may be typical for the child in terms of their learning style.  Recognizing that the gifted child needs to explore items in this way to satiate curiosity before being able to follow a structured plan can allow therapy to move along more smoothly and ease the stress the child may feel at being denied this learning opportunity.

It is important to note that in some cases gifted children are mislabeled as disordered due to the high degree of differences from the norm regarding characteristics of heightened awareness, sensitivity or intense focus on topics of interest.  Gifted children may appear to have social issues when they are with same age peers who are not at the same developmental level intellectually, yet when they are allowed to interact with older children or adults their social skills appear much more appropriate.  This difficulty with same age peers is often due to lack of shared interests, disparity in language skills or differences in emotional and moral development. For example, a gifted 6 year old may have ability and interest in playing high level problem solving games that his age peers cannot do, making it difficult to share experiences in play; a gifted 4 year old may use vocabulary words that his peers do not understand; or a gifted 10 year old may be highly disturbed by injustices observed on the playground or upset by social issues such as animal abuse or homelessness.
At times, the characteristics and asynchrony of gifted development can lead to co-morbid issues such as anxiety, OCD, or depression.  Many gifted children demonstrate asynchronous or delayed executive function skills that interfere with daily task performance.  Intense emotional responses of anger, frustration, sadness, joy, and excitement can look like rapid mood swings and interfere with social and task performance. Some gifted children become fearful of challenges in learning as they perceive themselves to be “stupid” if they can’t do it right the first time due to perfectionism and prior experiences where their talents allowed them great ease in learning.  These children benefit greatly from therapies that are structured to support their emotional and mental well-being in the context of their giftedness, understanding that it is often the disparity between the “thinking’ and the “doing” that leads to so much frustration for the gifted child.

When working with gifted children it is important to address the issues that are causing stress or reducing functional abilities within the context of their giftedness.  Therapists need to keep in mind that the gifted child can become resentful of adults who do not “meet them at their level” and challenge them sufficiently.  Under-estimating a gifted child’s ability can be as detrimental as providing too great a challenge.  As with any child in therapy, finding the “just right challenge” is always the art within the science. Educating yourself as a therapist about the unique needs of gifted and 2E children will allow you to adjust therapy so as to achieve the best possible outcome for this unique group of children.

Our Featured Contributor: Debra Johnson, MS, OTR/L
About the author: Debra Johnson, MS, OTR/L is the owner of STEPS for Kids, Inc in Yorkville, IL. She has been an OT for 22 years and worked in a variety of settings from pediatrics to geriatrics. She is passionate about providing quality care for children with a focus on remediation, education and wellness. As the parent of a gifted child with unique needs, Debra has a special interest in helping gifted and twice exceptional children and their families. Visit STEPS for Kids, Inc at
Please support our contributors and visit Debra’s company website Steps for Kids, Inc.

PediaStaff hires pediatric and school-based professionals nationwide for contract assignments of 2 to 12 months. We also help clinics, hospitals, schools, and home health agencies to find and hire these professionals directly. We work with Speech-Language Pathologists, Occupational and Physical Therapists, School Psychologists, and others in pediatric therapy and education.


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