Gifted Issues Discussion homepage Forums Twice Exceptional Gifted Overexcitabilities or ADHD outbursts?

My 2e son is gifted with ADHD. He has several emotional outbursts (frustration with self, anger at a classmate) per day at school. I thought this would get better over time, and it has. However, it's still occurring with regularity and is disrupting the classroom. This is a Montessori classroom where all is peace, love, and butterflies for most. My son is not reprimanded for these outbursts; his teacher very lovingly helps him through it or gives him space to handle it on his own. Most of the time the meltdowns are related to not being able to finish his work quickly enough (self-imposed standards) or a child has said or done something to which he takes offense ("you're being mean," "you are lying," or "that's not fair" are common statements). Perfectionism is a big problem.

My son is taking a low dose stimulant medication for the ADHD, and it has helped his focus. He could probably stand to increase his dose a little, but he seems to become more emotional when we do so. Anyway, I thought that since the medication is helping with the attention, focus, and impulsivity, it would help with the emotional outbursts as well. While the frequency and intensity of the emotional meltdowns have improved, we're still seeing them on a regular basis. The teacher is concerned and has called a meeting with the guidance counselor, who is very good. The teacher doesn't know what to do, and either do I!

I have been associating the emotional stuff with ADHD. Maybe it's related more to the emotional supersensitivity often seen with gifted children. If this is the case, do you just live with it? Do you accept it as part of your child, or do you try to help stop it? I am at a loss, and I'm so concerned that my son is alienating himself from other children. He is starting cognitive-behavioral therapy this week, and we go back to his doctor tomorrow. I'm concerned that she is going to want to add an SSRI (antidepressant) to his current stimulant med. It was scary enough starting the stimulant; I can't imagine adding another medication. Any experience with this?

Thanks for any advice you can offer. I really appreciate it.

Oh, and one more piece of information: when my son has these emotional outbursts, he initially seems angry, and then it quickly evolves into uncontrollable sobbing. He often makes statements about being stupid or things being too hard. When he's having the meltdown, he describes the feeling this way: difficulty breathing b/c he's holding his breath to try to hold it in, rapid heart beat, feels like he's losing control, his words: "feels like a balloon that is getting too much air and it keeps getting bigger and bigger; the air is pushing against the sides until if finally explodes".

The doctor (developmental-behavioral pediatrician) is concerned that it could be anxiety attacks? She suspects possible Generalized Anxiety Disorder in conjunction with ADHD (and giftedness). She does specialize in treating gifted children with ADHD. After I meet with her tomorrow, she might attribute this to the giftedness, but I could still see her wanting to try another medication in addition to the stimulant. I get the impression that her philosophy is that it doesn't always matter what it's called; what matters is what you can do to help the child feel/perform better.

Hi Jen,
Your description in your second post sounds very much like my DD - she's almost 8 and in 2nd grade.

She has described her losing control as "being trapped in a cage and that a weight is on her" She too starts out VERY angry and then it turns into sobbing and saying the same things about being stupid and/or no one likes her, has no friends, etc.

I'm very interested in what you say about it being anxiety attacks. That is something I never thought of.

Finally, how did you go about searching for a development-behavior pediatrician? This may be a Dr. we may need to see.

Thanks!

Hi Jen,
It is so tough to see your child struggle with frustrations!

It is hard to determine the root cause of his outbursts from a few short paragraphs so I'll share various scenarios regarding this kind of behavior and you can use the info to "peel back the onion" while working with your doctor and school.

Some kids with ADHD and executive functioning challenges have difficulty setting reasonable goals, dealing with frustration, understanding when "good enough" is better than perfect. They can be taught strategies to help handle these situations and set up realistic expectations. That said, their innate drive for perfectionism may still come into play.

One side effect of stimulant medication for some kids is emotional difficulty. While this most often happens as the medication is wearing off, for some kids the medication increases emotional sensitivity. Perhaps you can explore a different medication (as well as dose) - for instance he is on Concerta, switch to Adderal.

As your Dr suggested, perhaps there is something other than ADHD going on. Are you sure the diagnosis is correct and or complete? Things like anxiety, OCD, Bi-Polar often look like ADHD or often present along side ADHD. Could this be a possibility? What about undetected learning disabilities? Sometimes very bright kids mask LD. But, as they are working so hard to overcome, they can get frustrated and overwhelmed. Sometimes they benefit from a structured, explicit teaching approach to help them cope.

How is his sleep, diet, exercise?

I'm glad to hear that you are working with a cognitive specialist and developmental pediatrician. He or she may be able to help you understand the triggers and teach your son to recognize when outbursts are coming on and find strategies to deal with them.

I think you are on the right track. I hope that you get answers and relief soon.

Actually, since he started the medication, his outbursts have gotten better. We do tend to see increased sensitivity, however, when we increase the medication. Without it, he can hardly have a conversation due to distraction and lack of focus. When this happens, we see even more meltdowns. So, the key I think is finding the right balance/dosage.

We have tried multiple medications, and Concerta seems to work the best without increasing emotional lability or causing emotional meltdowns. For him, it doesn't last long enough, and he has to take a short acting booster (Ritalin) in the afternoon, but that's another topic. Some of the meds made him cry all day, as in sad, weepy, and clingy. He could never put his finger on why he was sad. Concerta doesn't do this at all. It just doesn't seem to help him control his frustration.



I honestly believe he has ADHD. What I'm not sure about is if he might have something else going on as well. My husband and I have researched symptoms of everything we could think of, and what seems to jump out at us repeatedly is generalized anxiety disorder. I just hate to over-diagnose him, ya know, especially if it's something he could grow out of or learn to manage. I feel like we've tried everything though. We've also looked into OCD, OCPD, and Aspergers, but the symptoms do not describe him. Anxiety fits the bill, but is it because he is just generally anxious? Is it because he's gifted but also has ADHD so he gets frustrated? He certainly suffers from perfectionism which I know is often linked to anxiety. I just don't know if it makes sense to treat the anxiety or try to "reverse" the perfectionism. Can we even do that?




Sleep is good, diet is ok (he eats healthy foods, but the stimulants affect his appetite a little. He eats a good breakfast and a good dinner, but he only eats so-so at lunch and rarely snacks unless he is home and I can push them.), and exercise is not that great. We can't seem to find anything that he's really into. He's active when given the opportunity, but as for extra-curricular sports, we've yet to find the one he likes and doesn't trigger major meltdowns. He says, "organized sports are just not my thing, Mom." I'm not sure if that's it or if he can't tolerate not being good at something immediately. Also, because of the ADHD, he needs it to really be "organized" or he gets lost. And, if it's too large of a group, he seems to get lost as well. He may just not be ready for team sports at this time. We do try to provide opportunities for exercise though. He gets to swim on a fairly regular basis. He has recess every day at school, although this is his least favorite time of day. He feels like an outsider with the other students during athletic activities. He's pretty small, not all that tough, and gives up way too easily.


Thanks, I am excited to start this. The therapist is someone I've seen for years (off and on since my first husband passed away 7 years ago), and I really trust him. He's wonderful with children and has become a family friend. He used to be a priest, and he even married my second husband and me.

Does anyone know of any books that you'd suggest for practical strategies we can implement at home and that I can go ahead and recommend at school? I am looking for strategies to help my son with ADHD, anxiety, and emotional hypersensitivity.

Thanks Mich! I appreciate the support and advice.

My son is 7, and is in the 2nd grade as well. He often tells us he has no friends and that nobody likes him. Later he'll start talking about a friend at school, so I think he does have friends. The teacher says he interacts just fine. He just speaks in absolutes a lot. If something happens one time, it "always" happens.

I'll let you know what the doctor says about the anxiety and whether or not she thinks these are actual anxiety attacks. When I researched in online, I read in multiple places that in children an anxiety attack can resemble a tantrum.

We chose our doctor based on a recommendation from a friend. We drive about 2 hours to get there. There are developmental-behavioral pediatricians in our area as well, but I felt better going to someone who was recommended. I really like her a lot, and she's good at tailoring the treatment to the specific child. My friend and I have boys the same age with similar issues, however they do have issues that set them apart. The doctor has prescribed different medications based on the differences she sees in our children, and she has made specific recs for each of us. I like this because I find that too many doctors have a one-size-fits-all, cookie-cutter approach to treating ADHD and related disorders.

Try google-ing "developmental-behavioral pediatrician" for your area. Then check for reviews online. You can also ask your regular pediatrician if they have a recommendation. Good luck, and I'll keep you posted on what we find out.

Peace, Love, and Butterflies! We have a 2e child also (but instead of ADHD he has autism) who has similar problems.

I, too, was trying to determine which were due to the gifted OEs and which were due to the autism, but have since given up since the whole package is intertwined. The main thing is that we all work together to help DS have appropriate behavior in the classroom. It doesn't matter what his over-reaction to something minor stems from, but how he can overcome it and get back to doing what he is supposed to be doing with the rest of the class.

Truthfully, I think a lot of his accommodations that he has in place due to his IEP for autism help with his OEs, but I am not going to say that. Do they let you make an IEP for gifted OEs? I don't know and I'm not going to ask to find out. The good news for us is that since he was diagnosed with autism very early (age 2.5) we have had 5 years to work on appropriate behavior...and it has been a LONG road with lots of specialists and therapies.

DS's behavior is not perfect, but I keep thinking what his teacher said this year: he is not her biggest problem. Woo hoo!!!

Anyway, to answer your question, if the behavior is disruptive to the classroom or to your child, I think it should be addressed and not ignored or "accepted." Behaviors that make our DS stand out too much really end up causing him anxiety and turn into a vicious cycle leading to more problems and disliking school.

Nan

Thanks Nanros. That makes sense. What does it matter what we call it as long as we can help, right? That's my philosophy for the day going in to see the doctor. Have a great day!

Yes. Our DS takes an SSRI as well as an attention med. They work very well for him in improving attention (which also helps him not panic in school) and fixing anxiety (which also helps him pay attention).

We found that the stimulant-class ADHD meds ramped DS up too much-- he became edgy and emotional, which made the anxiety worse. We switched him to a non-stimulant ADHD med, which is better for him at this point.

HTH, PM me if you want more details.

DeeDee

I concur that while it is important to question and be vigilant about medication, it is also critical to get the help the child needs. Anxiety and other issues can be debilitating. If medication is the solution or part of the solution, I'd urge you to keep an open mind just as you did with the stimulants. It sounds like DeeDee has some good experience to share. It is always reassuring to know you are not alone.

While you are looking at the medical side of things, I also urge you to look at the learning side. It can be VERY frustrating for bright kids to deal with LD's. Often they are able to compensate and hide LD's, but it comes at a emotional cost. He is only 7 and maybe what you are seeing stems from or is secondary to some challenges in learning. I would seek a full neuropsychological evaluation to help understand his learning profile better. Best case, you don't find any irregularities. Worst case, you identify some areas of challenge are in a better position to address them.