I agree with you Lorel, that gifted children can indeed also have AD/HD. It is in fact VERY important to identify that both conditions exist. And VERY important to consider the giftedness when making the diagnosis of AD/HD.
Everything I have read indicates that the process of identifying AD/HD is actually a process of ruling out many other things. I have personally treated many children in OT who are placed on meds for AD/HD symptoms only to have no change or even a worsening of symptoms. Some are gifted, some are not. But often the physician's response to that medication is to stop it and try another one or up the dose to get the "desired effect." When in reality the people assessing the child have simply failed to look at all the potential reasons for the behaviors being treated. I have also, for the record, seen dramatic changes in a child when the diagnosis is correct and medication is necessary. So please don't get me wrong. I am not making a case for the absence or non-existence of AD/HD. When it exists you know it. When treatment works, you know it.
I particularly like the resource by James Webb, PhD "Misdiagnosis and Dual Diagnoses of Gifted Children and Adults" when trying to determine what is going on for a gifted child. In regards to hyperfocus, Dr. Webb states that there are no empirical data that supports the theory of hyperfocus as an aspect of AD/HD. He notes that hyperfocus is an anomaly in some people with AD/HD, not a criteria for diagnosis. Gifted people also possess this ability to focus intently on specific topics and one author this "rapt and productive attention state" as "flow." So it would make sense that gifted people with AD/HD may in fact exhibit this "hyperfocus" and still have AD/HD.
There is empirical evidence of a condition called "perseveration" and the difficulty that a child/adult with AD/HD has with changing focus between one and task and another. This would imply that staying on one task is actually easier. That would support the clinical observation of "hyperfocus" which is typically seen when children are engaged in activities such as video games, sports activities, action movies or other fast paced but singularly focused tasks. Webb notes that school actually requires the ability to shift task focus frequently and divide attention between tasks that do not have an immediate or intrinsic reward. That makes school particularly difficult for the child with AD/HD due to this inability to SHIFT focus or regulate attention.
Basically, Webb sees the description of "hyperfocus" to be a less medical sounding description of perseveration and notes that the presence of it does exclude a diagnosis of AD/HD but that it can actually be the result of perseveration and inability to shift focus. He does not, however, state that it is a hallmark of diagnosis.
The SENG website has a checklist developed by Sharon Lind called "Before Referring A Gifted Child for ADD/ADHD Evaluation." I think it is a helpful resource if you question the diagnosis or are considering an eval for your gifted child.
http://www.sengifted.org/articles_counseling/Lind_BeforeReferringAGiftedChildForADD.shtml
