What to do? |
Recommendations for Teachers and Parents
These guidelines are taken from:
Bonnie Cramond, Ph.D., The University of Georgia, March 1995
The Coincidence of Attention Deficit Hyperactivity
Disorder and Creativity
When Attention Deficit Hyperactivity Disorder is suspected
- Recommendation 1: Be open-minded to the possibility that difficult behaviors may be indicative of special abilities,
such as creativity, as well as problems.
Research basis: There are many similarities in the behavioral manifestations of creativity and ADHD that may
cause errors in attribution (Cramond, 1994b). Farley (1981) and Shaw (1992) have speculated it is the very qualities
that are involved in the ADHD diagnosis that enable creative responses.
- Recommendation 2: Become knowledgeable about the behavioral manifestations of creativity and ADHD throughout the life span.
Research Basis: Although more recent evidence indicates that ADHD is a lifelong condition (Teeter, 1991), the very
behaviors that cause difficulties for children in school situations may be helpful in adult careers for which high energy,
risk-taking, flexibility in ideation, and ambition may be assets (Hartmann, 1993; Levine & Melmed, 1982; Winslow & Solomon, 1987).
Also, children with creative potential may not manifest consistent creative productivity, especially in certain fields, until
they mature (Bloom, 1985).
- Recommendation 3: Observe and record under what conditions the key behaviors are intensified or reduced.
Research Basis: Because ADHD-type behaviors may be exacerbated when the child is required to engage in unstimulating,
highly structured, repetitive tasks (Frick & Lahey, 1991), noting under what conditions the child is most likely to
exhibit the behaviors may be instructive. According to Farley (1981), sensation seeking behavior is increased in
- Recommendation 4: Ask the child what s/he is thinking about right after a period of daydreaming.
Research Basis: Because it is difficult to differentiate between inattention and diverted attention (Rutter, 1989),
it may be informative to discover whether the daydreaming child is not attending or is attending to alternative stimuli,
plans, or ideas that are focused.
If the child is referred for psychological screening
- Recommendation 5: Whenever possible, choose a psychologist who is knowledgeable about giftedness and creativity
as well as Attention Deficit Hyperactivity Disorder, or willing to learn.
Research Basis: Because there is no definitive test for ADHD, the diagnosis of this disorder is made
through the use of behavioral checklists. Such a diagnosis is susceptible to the interpretations of various
observers as to the frequency and severity of the behavior, and correlations of behaviors between parent and
teacher reports have been low (Biederman, Keenan, & Faraone, 1990; Schaughency & Rothlind, 1991). Webb (1993)
observed that few psychologists have had any training in recognizing characteristics of gifted and creative
children. Therefore, a psychologist who is willing to learn about the similarity of characteristics, perhaps
by reading a paper such as this, would be preferred.
- Recommendation 6: Be sure that a creativity test or checklist is complete in addition to the ADHD checklist.
Research Basis: Once the behaviors have been interpreted as deficiencies, it is unlikely that related proficiencies
will be seen. In a recent study (Cramond, 1994a), it was determined that half of the ADHD diagnosed group scored
above the 70th percentile on a test of creativity, yet only seven of the 34 (21%) children had been screen for the
gifted program. Eleven of these children, 32% of the ADHD group, scored above the 90th percentile, and only six
had been screened for the gifted program. None had any indications of observed creativity in their records,
although several and indications of other problems such as learning disabilities and emotional handicaps.
If the child is diagnosed as having ADHD
- Recommendation 7: Get a second opinion.
Research Basis: Even in a clinical setting with diagnoses based on interviews and judgement of symptoms indicative of the
DSM-III, reliability of diagnoses were very low (Werry, Methven, Fitzpatrick, & Dixon, 1983). The definitions and
criteria for diagnosis of ADHD have changed so often that even those who research ADHD are in conflict over its
causes and defining behaviors (Meents, 1989). Children diagnosed under one version of the DSM criteria would not
be diagnosed under another (Schaughency & Rothlind, 1991). Thus, whether a child is diagnosed with ADHD may depend
to a large extent upon when (Meents, 1989) and where (Levine & Melmed, 1982) the referral is made.
- Recommendation 8: Be cautious about recommendations for the use of methylphenidates or other drugs.
Research Basis: There is reason to be concerned that the increase in attention and left hemisphere enhancement
come at a price to cognitive functioning in other areas (Malone, Kershner, & Siegel, 1988), although some studies
have indicated that groups on medication perform as well or better on tests of creativity while they are on
medication (Funk, Chessare, Weaver, & Exley, 1993; Solanto & Wender, 1989). Other complicating factors
associated with the use of methylphenidates, of which Ritalin is the most commonly prescribed for ADHD,
include the worsening or inducement of depression (Weinberg & Emslie, 1990) as well as appetite reduction,
insomnia, increased irritability, headaches, stomachaches, motor and/or vocal tics, and suppression of height
and weight gain (DuPaul, Barley, & McMurray, 1991). However, for most children side-effects are mild and associated
with higher dosages (DuPaul et al., 1991). Of equal concern in assessing the costs and benefits of medication
treatment is the lack of evidence of any long term benefits of the medication (DuPaul et al., 1991; Meents, 1989).
In their review of the literature on the effect of stimulant medication on children with ADHD, Swanson and is
colleagues (1993) concluded that with medication one should expect temporary management of diagnostic symptoms and
improvement of associated features, but should not expect predictability of response, absence of side effects, or
improvements in long-term adjustment in terms of academic achievement or reduction of antisocial behavior (p.159).
- Recommendation 9: Be cautious about recommendations for an unstimulating curriculum with lessons broken into small parts.
Research Basis: Although such recommendations are common, the limited effectiveness of interventions on the long-term achievement
of children diagnosed with ADHD (Silver, 1992) cast doubt on their broad, continued usage. Zentall and Lieb (1985) found that a
structured prescribed-response condition reduced the activity levels of both hyperactive children and controls, suggesting that
structure is useful in decreasing activity level. However, Farley's (1981) research connecting both hyperactivity and creativity
to sensation-seeking lead his colleagues and him to a series of studies to investigate the aptitude-treatment interaction of
level of sensation seeking and crossed with educational environment, traditional, and structured versus unstructured and open.
He concluded that hyperkinetic children need arousing, unstructured, creative teaching to perform best, exhibit fewer hyperkinetic
symptoms, and report greater satisfaction with school. It is clear that given the heterogeneity of the group of children who are
diagnosed under the umbrella designation of ADHD, the needs of the individual child should be considered in designing a
modification in the curriculum (Silver, 1992). Gifted, creative children who exhibit behaviors typical of ADHD still have
the needs for complex, stimulating curriculum that other gifted, creative children require.
- Recommendation 10: Provide opportunities both inside and outside of school to enhance creativity and build self-esteem.
Research Basis: The emphasis in research and intervention with ADHD is on identifying deficiencies (c.f. Frick & Lahey, 1991;
McBurnett, Lahey, & Pfiffner, 1993) and remediating them (c.f. Burcham, Carlson, & Milich, 1993). Although good school-practices
for ADHD children should focus on strengths as well as weaknesses (Burcham it al., 1993), it is often up to the parents to provide
opportunities for expression of creative strengths outside of school. A negative label may affect not only the way a child is
perceived by teachers, but also the child's self esteem (Rosenthal & Jacobson, 1968). If medication is prescribed, there may be
psychological effects on attribution for behavior (Swanson et al., 1993), in that the child gives up responsibility for his
behavior and charges his good or bad behavior to the medication. Therefore, it is important to bolster the self esteem and
nurture strengths as much as possible within school and without. Parents and teachers should work together to help the child
find a mode of expression and learn to use that to get the ideas, emotions, and energy out productively.
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