High Intelligence as a Primary Diagnosis and Lens for Intervention with Children and Their Families

When my 18-month-old son was speaking in sentences, our part time nanny asked if she could bring him to one of her graduate classes at the U of MN Institute of Child Development.  Her professor said it was not possible for children to have such advanced language skills.  While I initially found the situation humorous, I realized it meant that child development experts knew very little about precocious kids.  I looked through graduate school textbooks and notes and did not find much information.  I knew what to expect for those on the lower end of the intellectual bell curve, with an IQ of 70 or below, and that it was not ethical for me to work with those clients without proper training. However, I knew little about what it meant to be on the high end of that curve, those with an IQ of 130 or above and yet I worked with very bright kids in my practice every day.   Hence began my quest to understand the gifted population.  That was 12 years ago and what I learned drastically changed the way I saw kids in my practice and what I do to help them.

High Intelligence is Neuroatypical. The ability to read at age three, have academic skills six years above their age level, and wrestle with existential concerns by age four is a result of unique neurological wiring.  Gifted brains have distinct brain structures-- they have double the glial cells, burn glucose more rapidly, and have faster, more efficient connections (1).  They think about things in elaborate creative ways, often looking lost in thought. The cortex thickens more rapidly with the ‘use it’ phase of developing high level circuits starting earlier and lasting longer (2).  There is also a delay in the ‘lose it’ or pruning phase that creates a lag in the development of executive functioning skills for as much as two to four years compared to average peers. Given academic success is largely dependent on ability to organize and get work turned in, this often results in underachievement and a misdiagnosis of ADHD.

Common Characteristics.  This wiring also creates many other unusual traits. Gifted kids often have Asynchronous Development (3), extreme differences in the development of abilities. They may talk early but walk late, reason like an adult but tantrum like a three-year-old or be a math whiz but struggle to read. This population is commonly associated with Dabrowski’s Overexitabilities, heightened sensitivities based on genetic characteristics (4).  These include:  

  • Emotional – intense feelings, strong emotions, deep concerns
  • Intellectual – curiosity, problem solving, never without a book, always asking ‘why?’
  • Psychomotor – always on the move, intense physical activity, talking
  • Sensory – heightened sense of taste, touch, sight, smell, and hearing.
  • Imaginational – highly creative, outside-the-box thinkers

They are idealists, whose grounding principles are often fairness and justice, often unable to move past it. They tend to be perfectionists and have a strong sense of guilt and deep personal responsibility. This creates six-year-olds exclaiming that they don’t deserve to live when they make a mistake or realize they cannot personally save the plant or wanting to give away their belongings to less fortunate children.

Factors for Positive Psychological Outcome (5). Overall, gifted kids show superior adjustment in responding to demands and are not at any greater risk for mental health issues, except Existential Depression and a slightly higher risk for anxiety and eating disorders in teens. Research suggests that the 3 main factors impacting emotional outcomes for gifted kids are:  

1)  Educational Fit - being properly challenged and ideally in full time gifted programs. Those NOT receiving an appropriate learning experience may show signs of depression as early as second grade. 

2) Type and degree of giftedness – the higher the IQ the greater the risk and difficulty in finding peers, fitting in with society and getting educational needs met.

3) Personal Characteristics - such as temperament, self-perception, and life circumstances.

So how does this change the work that I do?  When I first meet with a gifted child and his or her parents, I share what I know about this population.  Normalizing issues and strategizing ways to cope usually brings much relief and often diminishes concerns and symptoms.  It is comforting to know there are other six-year-olds who want to give away their belongings or experience so much sensory overload in the lunch room they cannot eat! 

I know there is often an existential basis for symptoms and the best way to deal with them is to understand they are not alone and that there are even ways they can take action, like being part of a collective effort to save the earth.   So when a 17-year-old is consumed with thoughts of death, like ‘what happens when I die’ and ‘when will I die’ but is not actively suicidal, or an eight-year-old says she cannot sleep because she is very worried that “science is going to change and the world is wrong,” we discuss life issues you can’t “Google” and how to cope with uncertainty.

I know that people with intense vivid imaginations can experience vicarious trauma including nightmares, flashbacks, and intense fears that impact daily functioning from seeing a music video or listening to the news. Treating the trauma as real and limiting exposure to media is important. When emotionally intense kids cry when their sports team lose or when they miss a point on an exam, they need mindful strategies to prevent social humiliation while also valuing their compassion.

I know that educational fit and a peer group are vitally important for psychological well-being. So when a young teen tells me his favorite thing to do it listen to Public Radio, I understand that his chances for finding a peer group is slim and we brainstorm where he can find ‘his people’. When a first  grader gets in trouble blurting out answers in the classroom and wishes they would teach something she didn’t already know, I take it seriously. Having clients assessed and finding the right educational fit is a key intervention and will often resolve behavioral issues and even mood symptoms.

It is truly a different world and understanding the unique traits and needs associated with high intellectual ability is essential in helping those clients gain insight and learn how to cope within it.  Psychologists doing therapy and/or assessment with this population need to be informed.  

Andrea Johnson, Psy.D., LP, received her degree in clinical psychology from the Minnesota School of Professional Psychology. She has worked or trained at the U of MN in Pediatric Neuropsychology, Mayo Clinic, Children’s Hospital in Minneapolis and The Children’s Hospital in Denver, CO.  She has presented at local and national conferences for 17 years, most recently on gifted kids.   She has been in private practice in Edina for 14 years.  

Lori Migdal, Ph.D., LP, received her degree in Clinical Psychology from the University of Detroit Mercy. She worked at The Roeper School, a preK-12 school for gifted students in Michigan.  She is in private practice in Lake Elmo and specializes in assessment and therapy of gifted kids.

For more information see:

Supporting Emotional Needs of the Gifted  (sengifted.org)

The Minnesota Council for Gifted and Talented (MCGT.org)

National Association of Gifted Children (NAGC.org)


1.     Eide, B, & Eide F. (2004) Brains on Fire: The Multimodality of Gifted Thinkers. Johns Hopkins School of Education on www.education.jhu.edu

2.     Shaw1,P.,  Greenstein, D.,  Lerch,J.,  Clasen, L.,  Lenroot, R., & Gogtay,N., Evans, A., Rapoport, J. & Giedd, J.  (2006).   Intellectual ability and cortical development in children and adolescents.  Nature 440, 676-679.

3.     Rivero, L. (2014). Many Ages at Once: The science behind the asynchronous development of gifted children.  Creative Synthesis at  www.psychologytoday.com.

4.     Daniels, S. & Plechowski, M. (2008). Living With Intensity: Understanding the Sensitivity, Excitability, and the Emotional Development of Gifted Children, Adolescents, and Adults. Scottsdale, AZ, Great Potential Press.

5.     Neihart, M. (1999). The Impact of Giftedness on Psychological Well-Being. Roeper Review. 22(1). 

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