Posted by: faithful | April 16, 2015

healing trauma: attachment, mind, body and brain

Healing Trauma: Attachment, Mind, Body, And Brain

Reviewed by Hilary Le Page, MBBS

Healing Trauma: Attachment, Mind, Body, And Brain.
Marion F Solomon, Daniel J Siegel, editors. .  New York, NY:  W.W. Norton and Company;  2003.   357.  CA $60.00.

The eight chapters of this multi authored book provided a synthesis of the work of leading researchers, clinicians and theoreticians in the fields of attachment, trauma and psychotherapy with the aim of enhancing the understanding of both the etiology and the healing of trauma. The initial chapters aimed to translate brain phenomena into readily understandable models of how biology and environment shape perception and behavior. The later chapters illustrated how this knowledge could be utilized therapeutically.

In the first chapter Daniel Siegal described an interpersonal neurobiology of psychotherapy: the developing mind and resolution of trauma. This read as a primer to the neurobiological basis of self-regulation, the healthy brain being one that can deal with complexity while trauma produced incoherent narratives because of impairments in integration of traumatic memory. Along with many other gems he mentioned the role of the 12 ‘C’s of psychotherapy (connection, compassion, contingency, cohesion, continuity, coherence, clarity, co-construction, complexity, consciousness, creativity, and community) and their neurobiological correlates in producing healing.

Chapter two, by Hesse, Main, Kelly and Rifkin, provided a review of the second-generation effects of trauma, how impairments in self-regulation could be transmitted from one generation to the next. The main argument was that lapses in the monitoring of reasoning during discussions of loss or trauma (when using the Adult Attachment Interview) might be subtle indicators of sporadic mental representational disturbances. These may cause subtle anomalous parental behaviours, which can have adverse effects. It was not trauma itself, but trauma without resolution, producing parental behaviours that were confusing to the child, that led to specific attachment patterns i.e. ”fright without a solution, when the infant, frightened by his attachment figure, has nowhere else to turn.” I was glad to read that, since initial descriptions of disorganized attachment behaviour of infants stressed their neurological normality. Later, the authors described other conditions in which disorganized attachment behaviours occurred.

Chapter three, by Allan Schore, described the building of the neural circuitry necessary for self-regulation, as the flow of information and energy created the mind, the regulation of the flow was essential to how the self developed. He described early relational trauma, how early traumatic dysregulating attachments impacted negatively on the maturation of the brain during its growth spurt from the last trimester to the middle of the second year (the period of accelerated growth in the right hemisphere). He also described a possible neurobiological genesis of antisocial personality disorder.

In Chapter 4, Bessel van der Kolk gave an over view of Post Traumatic Stress Disorder and reported on his explorations into the brain activity of subjects during the reading of a script recounting their personal trauma. This showed that the left Broca’s area was shut down during a flashback whilst the non-verbal right visual cortex was activated. These findings paralleled van der Kolk’s impression from his clinical work, disconnection occurred and impaired the ability to produce a verbal narrative.

Francine Shapiro and Louise Maxfield presented an overview of Eye Movement Desensitization and Reprocessing (EMDR) which, Shapiro suggested for the purpose of the chapter, should stand for Emotional and Mental Development and Reorganization. The goal of this would be to forge new connections between unprocessed memory and more adaptive information that was stored in other memory networks. In the wake of the tsunami, the descriptions of the use of EMDR to treat trauma (in the school children victims of the Mexican Earthquake) using a group program developed by the members of the EMDR Humanitarian Assistance program, might be especially relevant.

In Chapter 6, Diana Fosha described, Accelerated, Experiential-Dynamic Psychotherapy (AEDP). In a case example, she demonstrated how to work with the affective experience of the client in the “stuck” state that originated in a mother-child traumatic experience. The process, which involved experiencing and expressing emotion, empathic reflection by the therapist, and somatic focusing and reflection, allowed the client to be freed from the constraints and somatic rules imposed earlier in life and to make fresh choices in the present.

In Chapter 7, Robert Neborsky described his method of short-term dynamic psychotherapy as related to the insecure attachment framework. He theorized that layers of feelings and defenses were formed because sub-optimal attachment experiences gave rise to a “primitive aggressive self-organization (PASO).” His therapeutic focus was the experience of the core emotions related to the PASO in the therapy. He illustrated this by a case example covering six hours of therapy.

In the final chapter Connection, Disruption, Repair Treating the Effects of Attachment Trauma on Intimate Relationships, Marian Solomon described a model for couples therapy. In this model, marital disagreements were seen as the outward sign of unresolved attachment yearning with resultant emotional disengagement leading to anger and despair. Her method involved focusing couples on the defensive processes that blocked emotional responsiveness during effective repair, since effective repair was seen as essential for secure attachment.

A colleague confided to me when I said I was reviewing this book that she had borrowed it from the library 8 months previously and hadn’t been able to return it yet.

It is a book which constantly made me want to hunt out the source references, raised many questions, updated my knowledge in the area of attachment and trauma theory and renewed my enthusiasm for short term dynamically oriented psychotherapy. All in all, this book was a great, even if at times not easy, read and a worthy addition to my personal library and yours.

Posted by: faithful | January 25, 2015

clergy recovery (focuses on addictions)

Clergy Recovery Links

This list is provided solely as information. Only you can decide which, if any, of these resources might be helpful to you. Listing comes with no guarantees, promises, recommendations or endorsements. Exclusion from this list does not imply anything either.

Please read the full disclaimer that applies to all resources listed on this site.

Finding help which suits you best will save your time on your recovery journey, give you hope more quickly and be most cost efficient. If you wish you may consult with the Clergy Recovery Network regarding referrals on this list and regarding other resources as well. We believe in helping you find a quality fit as you seek help. No resource pays CRN to refer clergy and their families. Some of the resources listed below offer financial advantages for the clergy whom CRN refers. If you wish to interact with us regarding our assessment of your needs and the referral that deems most appropriate please go to the Contact page.

This full disclaimer applies to CRN’s interaction with you regarding referrals.

Church Consultants/Conflict Resolution

  • Peacemaker Ministries
    Ken Sande and his team work with churches and Christian Ministries which are conflicted. They use a conservative Biblical model of consulting.
  • Shawchuck and Associates
    Norm Shawchuck and his staff are highly trained and experienced in consulting with churches in conflict and crisis. Norman may be reached toll free at 800-359-7363 or you may email him at


  • Bethesda Workshops
    An intensive workshop program for male and female sex addicts, co-sex addicts (partners or ex-partners of addicts), and addict/co-addict couples.
  • Charis Foundation
    Offers intensives and seminars for pastors.
  • Faithful and True Ministries
    Intensives for men and couples struggling with sexual issues located in Minneapolis, MN. Books, articles and other resources are also available at this site.
  • Link Care
    The Restoration and Personal Growth Program exists to meet the needs of missionaries and pastors who have encountered difficulties in their fields of service.
  • Marble Retreat
    Marble Retreat offers eight-day intensives which include group and individual Christian counseling.
  • Ministry Development Council
    The Ministry Development Council is a National Network of Accredited Centers Providing Resources for Clergy, Denominational Leadership, and Local Churches.
  • Psychological Counseling Services
    Located in Scottsdale, Arizona. Individualized intensive outpatient therapy, with expertise in a number of life issues including, sex therapy and addiction, relationship difficulties, marriage and family issues.
  • Stone Gate Resources
    Brief Intensive Counseling/Restoring Sexual Purity Workshops for couples.
  • The Cottage on Coronado Island
    One week retreats/intensives for individuals and couples in San Diego for Christian leaders with Walter and Francoise Becker.
  • The Ministry Development Network
    An ecumenical, church owned service whose mission is to strengthen and care for persons in ministry.

Denominational Resources

  • Chemical Dependency Ministries (UMC)
    A United Methodist ministry (Oklahoma Conference) which recognizes that the disease of addiction is also a spiritual issue. This ministry provides education and resources to offer hope, healing and understanding within our communities.
  • Fellowship of Recovering Lutheran Clergy
    Recovery support for Lutheran clergy who suffer from alcoholism and other addictions.
  • Presbyterians for Addiction Action
    PAA assists Presbyterians as they minister in an increasingly addictive society to restore people to God’s promise of wholeness.
  • Recovery Ministries of the Episcopal Church
    Recovery Ministries is an independent, nationwide network of Episcopal laity and clergy, dioceses and parishes, schools, agencies, and other institutions—all with a common commitment to address the use and misuse of alcohol and other drugs.


  • Pastor Care
    PastorCare provides personalized support and encouragement for pastors and their families.
  • Recovered Alcoholic Clergy Association (RACA)
    The Recovered Alcoholic Clergy Association (RACA) is a working fellowship of the clergy of the Episcopal Church. It is open to ALL clergy.

Other Resources

  • Christian Recovery International
    CRI, the host site of CRN, is loaded with recovery articles and international language sites. It has networking opportunities, training resources like the Fuller Institute for Recovery Ministry, and abuse recovery pages like Spiritual Abuse Recovery.
  • Covenant Eyes
    Covenant Eyes is a site which provides monitoring and filtering of your web use. The founders are wonderful believers and the staff is fantastic with technical and customer care.
  • Keith Miller Recovery Resources
    Keith Miller is a bestselling author who has his own recovery journey and shares it. He writes incisively on recovery themes. In March 2009 his web site will be redesigned. His weekly newsletter is priceless for pastors.
  • Winning Edge Ministries
    Thomas Pedigo has written a broadly endorsed manual titled, “A Program for Restoring Fallen Ministers & Religious Leaders”. It and other resources are available at the Winning Edge web site.
Posted by: faithful | December 26, 2014

dealing with the narcissist in your life

How To Deal With The Narcissist In Your Life

Posted: 12/23/2014 8:24 am EST 

The author of The Narcissist Next Door: Understanding the Monster in Your Family, in Your Office, in Your Bed — in Your World explains how to deal…without destroying yourself.

By Jeffrey Kluger

Hyacinth Manning/Superstock/Getty Images

Narcissists are the kudzu of the human condition — a rapidly proliferating species that shows up anywhere, thrives everywhere and resists all attempts to wipe them out. There are a lot of reasons for that: They’re charismatic, articulate and often brilliant. They have the power to charm the pants off of you — sometimes literally — which means they breed a lot, leaving plenty of little narcissists behind. (And yes, there’s a genetic component to the condition.)

What this means is that you are all but certain to encounter narcissists, at any given time, on any given day. The question is how to deal with them. Here are five places narcissists lurk — and what you should do when you find them.

The Narcissist in the Corner Office

Diana Ong/Superstock/Getty Images

You know this boss; you’ve probably had this boss. He — or increasingly, she — is the boorish, bullying, arrogant, blame-laying, credit-grabbing monster who haunts your days. You’re not alone. According to one 2007 study by the polling firm Zogby International, 37 percent of all workers in the U.S. have at some point been bullied on the job — or, a whopping 54 million people, when you calculate from a conservative estimate of the size of the workforce.

The most delightful way to cope with this kind of narcissist is to find another job, slap your resignation letter on the little despot’s desk and walk on out. But that’s not always an option. So, for as long as you’re stuck in a bad gig, remember these coping strategies:

If possible, always pitch the boss a new idea in a group setting, rather than to the boss alone. The more people who hear that the idea is yours, the harder it is to steal.

When the boss blames you for a problem that’s actually his or her fault, resist the panicky impulse to pass that blame further along to a subordinate. This leads to what’s known as a blame contagion that can cycle all the way down the organizational chart. Better to cop to anything that truly is your fault, explain the things that aren’t—and do it all in a traceable, storable e-mail chain.

Don’t stand for being bullied — verbally or physically (and yes, that happens). Document every single incident of abuse and report them all to human resources. If other people witnessed the incidents, ask them to back you up. And to the greatest degree possible, take none of this personally. The boss’s narcissism really is about the boss — and that explains a lot about what motivates narcissists.

In 2009, Nathaniel Fast, PhD, a professor of management and organizational behavior conducted a study of 410 people employed at various levels in various companies and found that aggression and abusive behavior come from a particular combination of authority and self-perceived competence. Repeatedly, he found, the most dangerous people are the ones with a lot of power but not as much confidence — which means they are deeply insecure about being found out. That makes them intolerant of any criticism or contradiction — and that, in turn, can lead to misbehavior when they feel threatened.

Bosses are particularly susceptible to this lethal combination because their charisma and confidence means they interview well, but that also means they have a higher than average chance of getting hired for a job they may secretly know they’re not qualified to perform. “Search committees can’t get enough of these guys,” says management expert Robert Hogan, of Hogan Assessment Systems. You, by contrast, will have more than enough of them very quickly.

The Narcissist in the Next Cubical

Some of the same rules that apply to a narcissistic boss apply to the narcissistic co-worker — particularly avoiding the blame game and protecting your ideas. But there are differences, too.Narcissistic co-workers can be great in the early stages of a group project — say, when you’re brainstorming ways to land a new client. That makes sense: The work is usually done in groups, where individual contributions get noticed and applauded; recognition is the narcissist’s drug of choice. If your focus is on what’s best for the team, don’t begrudge the narcissist the spotlight — but don’t be shy about pulling it to yourself when you have something of your own to contribute.

The bigger risk comes later — when the work is more about managing the account, meeting deadlines, holding the nervous client’s hand. There’s no audience for work like that, and so the narcissist will slack off, letting other people carry the load. Don’t permit it. The group should have a way of accounting for hours logged and tasks completed, and the narcissist should be included in those ledgers.

Even in businesses that don’t work by billable hours, there are ways to keep track of how much of a contribution any one person is making. An unnamed narcissist at an unnamed magazine in my past was forever shirking work — taking on fewer and fewer assignments and claiming chronic illness as a reason. A quick byline count on the magazine website provided an exact accounting of who in our department had been producing what — and who had been producing next to nothing at all. In the next round of layoffs (and there were plenty in that era), the narcissistic colleague became an ex-colleague.

The Narcissist in Your Bed

DEA/G. DAGLI ORTI/Getty Images

Get out of bed. Run away. Don’t look back. Any questions? Okay, maybe it’s more complicated than that. It’s very easy to fall for the charm of a narcissist; and since charm often equals sexy, and sexy often equals sex, things get messy fast. Paradoxically, narcissists are often quite faithful in the early stages of relationships, because what frequently leads people to cheat is insecurity: If you’re afraid the person you love doesn’t love you back, you begin looking for your next landing spot. Narcissists can’t conceive that they’re not adored, so they don’t go through that phase.

But they’ll cheat soon enough, because for narcissists, a relationship is all about how the partner enhances their own self-image. That means always trading up to someone who’s younger, prettier, richer — or just plain newer. Narcissists will lie about where they’ve been and what they’re doing; they’ll listen less and less when you speak (not that they ever listened much to begin with), and they’ll leave you flat if you don’t leave first.

If you’re married to a narcissist you’re in a lot deeper. Here you must confront the problem squarely and suggest — indeed, insist on — either marriage counseling, individual therapy for your spouse, or both. Narcissists resist that, since the nature of the condition is that they don’t accept that anything is wrong with them. But stand your ground — and if that doesn’t work, consider leaving the marriage. You deserve better.

This broad rule holds for both sexes, but when it comes to romance, women really are in greater peril than men. A 2008 study, by a researcher at New Mexico State University, looked at the improbable attraction many women have to men who exhibit the so-called dark triad of personality traits: narcissism, Machiavellianism and impulsive thrill-seeking. The paper crunched the statistics and found that these men outscore other men in number of sexual encounters in any given week, month or year. If you’re seeing or married to one of these guys, that alone argues for getting single or unmarried fast.

The Narcissist in Your Social Circle

Hyacinth Manning/Superstock/Getty Images

The narcissistic friend is the one who can go out drinking with you, talk all night about her job and her boyfriend and her vacation plans, and never think to ask you about how you’re doing.It’s often not necessary to toss aside a narcissistic friend if you’re getting some satisfaction from the relationship. Like what? Invitations to good parties, funny stories, someone to go out and have drinks with. But it’s best to do your socializing in larger groups or, if you do socialize with the narcissist alone, lower your expectations for the evening. Some narcissists — the ones with a low-grade case of narcissistic fever — might respond to a little good-natured teasing. When I lived on the second floor of an apartment building with a narcissistic friend who lived on the fourth, and we were making plans on the phone to go out for drinks, he said to me, “Okay, come get me on your way out.” That’s a statement that ought to come from the person on the lower floor, unless the person higher up is entirely self-absorbed and needs to be collected and squired. My response: “Um, are we going via roof helicopter?” It got a laugh, it made the point and I think our friendship inched ahead a little.

The Narcissist in Your Family

Hyacinth Manning/Superstock/Getty Images

You know the sister who never talks about anyone but herself? The uncle who holds forth at Thanksgiving dinner, from the pumpkin soup straight through the pumpkin pie and brooks no interruption, and certainly no contradiction? You know the parent or grandparent or even offspring who has never been heard to utter the words, “So how are you doing?”Well, get used to them, because you’re stuck with them. For the most part, there’s no divorcing or quitting or firing your family. Even though you only see them at holidays, weddings and funerals, they’ll always be a fixture in your life. That means finding ways to deal with them.

The answer, most psychologists say, begins with the same advice that applies to dealing with a narcissistic boss: Don’t personalize it. The self-adoring family member is responding to an inner script, which is very often a painful script. That’s worth keeping in mind.

It can also help, say therapists, to establish your boundaries: Make clear what you expect from a relationship, or at least a conversation, and that it must include some reciprocity. Narcissists are characteristically obtuse, but they do have a learning curve. When your relatives make short work of you often enough at family gatherings — turning away to have a rousingly good conversation with the person seated across the table — the message does get through. “It’s possible,” says psychologist W. Keith Campbell, PhD, of the University of Georgia. “But it’s not the natural course of things.”

Better still — if you can abide it — is simply to wait the narcissist in your family out. The old wisdom about personality disorders like narcissism was that they’re intractable. Once you’ve got the diagnosis, you’re stuck for life. But in 1990, psychologist Mark Lenzenweger, PhD, of The State University of New York at Binghamton launched a 16 year longitudinal study and found that it’s possible for people simply to age out of narcissism — at least a little.

“We did see something that was not so much spontaneous remission as it was maturation,” Lenzenweger says. “The disorders just seem to clear for some people.”

Spending the next few decades waiting for the narcissist in your family to shape up is not a pretty prospect. But if compassion counts for anything, remember: It is far easier to know a narcissist than it will ever be to be one.

Jeffrey Kluger is the author of The Narcissist Next Door: Understanding the Monster in Your Family, in Your Office, in Your Bed— in Your WorldandThe Sibling Effect: What the Bonds Among Brothers and Sisters Reveal About Us. He is also an editor-at-large at TIME Magazine and

Posted by: faithful | December 2, 2014

natural remedies to treat bipolar disorder


Bipolar disorder, also known as manic-depressive disorder, is caused by chemical imbalances in the brain and is characterized by unusual swings in mood and energy level. According to the National Institute of Mental Health, 5.7 million Americans are affected by bipolar disorder. That’s about 2.6 percent of the population of adults over 18 years old. There is no cure, but for those affected, typical treatment options often include the use of mood-stabilizing medications such as lithium, as well as antidepressants and psychotherapy.

Many people with bipolar disorder also choose to examine natural treatment options. These treatments, like diet and exercise, are focused on heading off both manic and depressive symptoms by reducing stress in a patient’s life in hopes of lowering the likelihood of triggering a bipolar episode.

For the most part, these alternative treatments have been studied less by medical professionals than have traditional medical treatments. However, many bipolar patients have had success pursuing them.

Food Remedies to Treat Bipolar Disorder


Watch what you eat. We’ve all heard that a proper diet is important to our overall health and can help reduce our chances of getting a number of diseases, from heart disease and high blood pressure to diabetes. Proper diet can also help manage bipolar disorder. Doctors suggest avoiding diets that are high in saturated fats, trans fats, and simple carbohydrates and instead seeking out foods that are nutrient dense, such as whole grains, fruits, vegetables, and lean protein.

Doctors also recommend avoiding caffeine, which can alter mood and disrupt sleeping patterns.

There are some foods, like fatty fishes, that may improve bipolar disorder. Some medical experts suggest eating salmon, herring, mackerel, trout, and albacore tuna at least twice a week.

If you don’t like eating fish, taking fish oil supplements can be a good alternative. The omega-3 fatty acids found in fish oil are thought to reduce irritability and lessen mood swings in people with bipolar disorder. Omega-3s can also be found in flaxseed oil.

To treat symptoms of depression, some suggest using the supplement 5-HTP (5-hydroxytryptophan), which is thought to be a precursor to the creation of serotonin. Serotonin is a neurotransmitter in the brain linked to calm moods and improved sleep.

There is some indication that herbal supplements, like ginseng and St. John’s wort, are effective in relieving depression. Some studies have shown, however, that St. John’s wort may be linked to triggering manic episodes in bipolar patients.


Exercise. Whether or not you have bipolar disorder, studies show that exercise can improve mood. Moderate and regular exercise releases chemicals called endorphins that cause feelings of euphoria and help regularize sleep patterns. Also, studies of bipolar disorder have linked it to a higher risk of heart disease, diabetes, and obesity. Exercise promotes heart health and can help you maintain a healthy weight.
Sleep for your health. Getting enough sleep is an overall necessity for good health. However, getting enough sleep can be difficult for those with bipolar disorder. Patients can go through manic periods when they don’t get enough sleep, or depressive periods when they sleep too much.

Getting on a regular sleep schedule can help stabilize your mood. Establish a routine with a regular time for going to sleep and waking up. Make sure your bedroom is as comfortable as possible, and limit other activities that aren’t sleep related. For example, if you’re used to using your bedroom as a home office, you may consider moving your desk and computer. You don’t want to be worried about work while trying to get a good night’s rest.

Beating stress. Anxiety and stress can be triggers for bipolar episodes. Patients may want to try the following exercises to beat stress:

Deep breathing. Sit quietly, breathing slowly through your nose. On your inhale, fill your lungs deeply with air. Hold your breath for a few seconds and slowly exhale through your mouth. Repeat.

Meditation. An ancient practice, meditation relaxes your mind and body by allowing you to focus on one thing, such as your breathing, an object, or a sound. The idea is to clear your mind of distracting thoughts that are potentially causing stress. Meditation can be done solo or in groups.

Yoga. Not only does yoga contribute to overall physical fitness, but the stretching and balancing techniques, coupled with a focus on breathing and meditation, can leave you feeling calmer and energized.

Herbal remedies. Some bipolar patients have found success treating their illness using over-the-counter supplements. Though many of these treatments have not been proven in clinical trials, some people have found them effective in stabilizing mood or relieving symptoms of depression.

Check with you doctor. As with any new diet, exercise, or alternative regimen, it’s important to check with a doctor to make sure that your methods are safe for you or your loved one.


Posted by: faithful | November 27, 2014

divorcing (or leaving) the character disordered….

Divorcing The ‘Character Disordered':

An Interview With Dr. George Simon

Posted: 04/09/2013 

Many of us might be inclined to describe our exes as “crazy.” After all, divorce doesn’t normally bring out the best in folks. But according to Dr. George Simon, some divorces may be exceptionally toxic because one party suffers from what he terms a “character disorder” (CD). Divorcing a disordered person is its own particular kind of hell, distinct from the usual miseries of divorce.

Simon is a psychologist who has spent over 25 years researching character disturbance and has written two acclaimed books on difficult personalities — “In Sheep’s Clothing: Understanding and Dealing with Manipulative People” and “Character Disturbance: The Phenomenon Of Our Age.” I interviewed Simon about his views on divorcing someone with a character disorder.

How do you know if you’re dealing with someone who is truly disordered, or someone who is just being a difficult jerk? I wonder if the distinction matters?
Dr. George Simon: CDs really can’t help themselves when it comes to being who they are. Yes, some are very adept at positive impression management and manipulation, but if you know what to look for, you can tell.

But first you must divest yourself of many popularly held but erroneous beliefs about human nature: Not everyone is struggling with fears and insecurities… and not everyone who puts on an air of confidence or superiority is compensating for low self-esteem. There really are people who sincerely think they’re all that and are therefore entitled to do as they please regardless of the consequences! People reveal their true character mainly in their core beliefs — which are reflected not in what they say, but in their actions.

Top CD attitude red flags: Entitlement, possessiveness, indifference to others, arrogance, disdain for obligation. The more of these attitudes they possess and the more intense these attributes are, the more character impaired the person is.

How does someone who is character disturbed behave differently in a divorce? Is it more contentious?
GS: There are hundreds of examples. But here are a few: For the CD, it’s not about acknowledging failure in the marital relationship, separating, and moving on. Rather, it’s about punishing, destroying, or making someone else’s life miserable for daring to say “no” or declare an end to an abusive situation. Character assassination becomes the norm. The CD will arm their attorneys with examples of their ex’s “questionable behavior,” which are amplified to such an extent to paint the worst possible picture of the person.

Perhaps even more important is the ordeal the CD wants to be sure the ex-partner goes through. They’ll bring out such big cannons with their lawyer, that the other party has to spend much time, energy, and money either defending themselves or just trying to survive the ordeal that they have no time, energy, or money left to advocate for a stronger position.

Are CDs financially abusive?
GS: Money matters always tell the story the best. The CD will clean out bank accounts. Or they play financial games. The reckless gambling and spending will all get discovered right around the time the aggrieved party has begun seriously contemplating the divorce. This makes it even harder to think about throwing in the towel because of how disadvantaged the victim will be walking out.

The CD will also try to penny-pinch or in other ways attempt to ensure that their former partner can’t simply walk away in a financially tenable position. The worst CDs will want to see their former partners financially broken and destitute. The last thing they want is simply to separate and allow the other person to be on their feet and move on to a different (better) life. Rather, they want them — at least from a financial standpoint — to rue the day they decided to call it quits.

How are children affected?
GS: CDs triangulate the kids and use them as pawns and weapons of war in divorce. As pathetic as it already is for CDs to treat the person they supposedly once worshiped so horrendously, their willingness to use their children to emotionally wound their partner is even more reprehensible. But the greater the character disturbance, the less compunction the CD has to use the kids in this way. Alienating kids from the other parent. Trying to sabotage whatever positive relationship there is. Bribing and trying to buy affection and allegiance, not just with money but with superficial attentiveness, attention, seduction, and placating.

What motivates someone who is CD?
GS: It depends. There are two major CD types, the narcissistic and the “aggressive” personalities. For the narcissist, no one else really matters. The cardinal feature will be a complete indifference and insensitivity to everyone else’s welfare and a pathological determination to save face.

For the aggressive characters, it’s all about “winning.” And while this always includes ensuring the defeat of the opponent, in some cases (as in the case with the sadistic aggressive) it’s also about humiliating the other person and relishing in the pain they might be able to cause them.

So how do we deal with them, aside from divorcing them? Should we try to achieve some kind of consensus around co-parenting, for example?

GS: You have to understand that CDs don’t play by the regular rules, so trying to reach consensus with them and exhausting yourself trying to get them to “see” the unhealthiness of their ways is pointless. I have a rhyme I like to use: “It’s not that they don’t see, it’s that they disagree.”

Character disordered people are not stupid people. They’re contrary people. They know what the generally accepted rules are, they know what most people’s expectations are. But they haven’t made the decision in their heart to play by the rules most of us want them to play by. That’s a matter of the heart.

Trying to reason with them to examine their behavior assumes something that is patently untrue. It assumes that what they need is insight. I make that point in my book. We live under this delusion. Therapists do this all the time! They think they are going to be the person who says just the right thing in just the right way, so that this time a light bulb is going to go off in this person’s mind and all of a sudden they will understand and “see” the error of their ways! The problem is, they already understand!

It’s not that the disturbed character doesn’t know what they’re doing and what damage comes from it. If the wounded party is crying their heart out and is miserable, it’s not like you don’t know what you’ve done and what an effect it has had — it’s right there. They already see this but disagree with the notion that they should conform their conduct and work to make amends.

They’ll change only when the cost of their behavior rises too high and the benefits of doing something different becomes more clear. It’s not that people can’t or won’t change. It’s under what circumstances they’ll be motivated to change. What you need to do if you’re in a relationship with someone like this is set those limits and enforce those boundaries.

You must set the terms of engagement. You can’t trust the character-impaired person to do it. When there is a clear cost to continuing their crazy behavior, there will perhaps be some incentive to change.

Dr. George Simon blogs about manipulative people at

Posted by: faithful | November 10, 2014

misdiagnosis and giftedness in children

That’s not autism: It’s simply a brainy, introverted boy

Autism spectrum diagnoses are up 78 percent in 10 years. We’re dramatically overdiagnosing it in everyday behavior

That's not autism: It's simply a brainy, introverted boy(Credit: Humannet, Luiscar74 via Shutterstock/Salon)

I have followed William in my therapy practice for close to a decade. His story is a prime example of the type of brainy, mentally gifted, single-minded, willful boys who often are falsely diagnosed with autism spectrum disorder when they are assessed as young children. This unfortunate occurrence is partly due to defining autism as a “spectrum disorder,” incorporating mild and severe cases of problematic social communication and interaction, as well as restricted interests and behavior. In its milder form, especially among preschool- and kindergarten-age boys, it is tough to distinguish between early signs of autism spectrum disorder and indications that we have on our hands a young boy who is a budding intellectual, is more interested in studying objects than hanging out with friends, overvalues logic, is socially awkward unless interacting with others who share identical interests or is in a leadership role, learns best when obsessed with a topic, and is overly businesslike and serious in how he socializes. The picture gets even more complicated during the toddler years, when normal, crude assertions of willfulness, tantrums, and lapses in verbal mastery when highly emotional are in full swing. As we shall see, boys like William, who embody a combination of emerging masculine braininess and a difficult toddlerhood, can be fair game for a mild diagnosis of autism spectrum disorder, when it does not apply.

Jacqueline, William’s mother, realized that he was a quirky baby within weeks of his birth. When she held him in her arms, he seemed more fascinated by objects in his field of vision than by faces. The whir and motion of a fan, the tick-tock of a clock, or the drip-drip of a coffeemaker grabbed William’s attention even more than smiling faces, melodic voices, or welcoming eyes. His odd body movements concerned Jacqueline. William often contorted his body and arched his back upwards. He appeared utterly beguiled by the sensory world around him. He labored to prop himself up, as if desperately needing to witness it firsthand.

Some normal developmental milestones did not apply to William. He bypassed a true crawling stage and walked upright by ten and a half months. He babbled as an infant and spoke his first words at twelve months; however, by age two, he was routinely using full sentences and speaking like a little adult.

When William encountered an interesting object or event as a toddler, he became so captivated by it that he completely ignored the people around him. During a music class, he once stood off to the side, staring at a ceiling fan while all of the other kids sat together singing. Then suddenly, William ran toward the teacher. He was mesmerized by the synchronous movement of the teacher’s lips and fingering of guitar strings that together produced melodic sounds, to the point of losing all awareness that his face was just inches away from his teacher’s. At his two-year birthday party, while the other kids were playing in the backyard, William methodically took some folding chairs, lined them up, and pushed them over one at a time—intrigued by the noises the falling chairs made. He repeated this series of events over and over throughout the afternoon, as if conducting a series of well-crafted experiments.

By age three, William began developing a passionate interest in a range of adult-like topics. After being read a book on Pompeii, he talked endlessly for months afterwards about what he had learned. He pressured Jacqueline to check books out of the library on Pompeii in order to satisfy his need for more detailed knowledge on what Roman life was like before Mount Vesuvius erupted and buried the ancient city in ashes. He strove to know more about aqueducts and amphitheaters. He insisted that Jacqueline design a toga for him, which she did. He strutted around the living room not just pretending to be, but believing that he was, a citizen of the Roman Empire, circa AD 79.

Steve, the lovable host of the children’s TV program “Blue’s Clues,” became an idol for William. He avidly watched reruns of the show and lobbied his parents hard for a green shirt, khaki pants, and brown shoes so that he could look just like Steve—no compromises.

Next he became fascinated with the Titanic, amassing a detailed knowledge of the design of the ship. Facts such as the exact length of the Titanic (882 feet, 9 inches) mattered to him. He also knew that its top speed was 23 knots. William insisted on having a uniform just like Captain Smith’s, the officer who was in command of the Titanic. Getting the color and the arrangement of the stripes and buttons correct seemed essential to William when he and his mother designed it. Jacqueline also helped William amass an impressive collection of pictures of ships, ocean liners, and uniformed officers, which he studied on his own for hours on end.

At preschool, William was a veritable pied piper. During his “Titanic phase,” he arrived at school sporting his Captain Smith blazer and cap. He orchestrated Titanic reenactment scenes, assigning roles and telling his classmates where to stand and what to do and say. This would usually go well at first. William’s enthusiasm was intoxicating, and the play scenes he devised were too exciting for the other kids to pass up. However, more often than not, the other kids eventually lost interest and wandered off because of William’s need for them to follow his script.

At home, William’s tantrums were wild and uncontrollable even as he approached age five. When he was asked by his parents to turn the TV off and join the family for dinner, he might scream and yell in protest, writhe around on the floor, and even throw and break things. Invariably, the situation that caused William to fly into a rage involved setting aside what he was doing in the moment to comply with a routine request—such as to get ready for bed or dressed for preschool. He simply hated transitions. Unless his parents regularly planned activities that were in line with his interests, William inevitably became agitated, overactive, and unmanageable.

Mealtime was another “powder keg” situation. William was repulsed by vegetables. If carrots, broccoli, or any other vegetable was placed on his plate, he thought nothing of throwing the entire dish on the floor. All he could stomach was a short menu of items like pizza, hot dogs, or peanut butter sandwiches.

William’s parents were sociable. They spent a great deal of time in the company of other parents and children. They knew William’s tantrums, fussy eating habits, and social difficulties were outside the norm. Their friends’ kids were maturing, while William seemed stuck. When William was five years old, they decided to have him evaluated. A highly respected doctor at a university-based institute was sought out to conduct the initial evaluation. During a twenty-minute observation, William mostly sat staring at the doctor’s bookshelves—either ignoring or providing one-word answers to the questions he was asked. At the end of this brief observation, the doctor concluded that William was “on the spectrum” and had Asperger’s syndrome. The doctor reassured Jacqueline that her son’s difficulties were due to him having a brain disorder and that she should in no way hold herself responsible. He advised her to have further testing conducted through the institute to confirm the diagnosis and to approach her local regional center to obtain services for him—“Mostly as a precaution in case he can’t take care of himself when he gets older.”

Years later, when recounting this experience for me, Jacqueline said this news was like a “blow to the solar plexus.” But she convinced herself that failing to trust the conclusions of a highly respected doctor from a prestigious university hospital was nothing short of staying in denial about William. She followed through with a recommendation to have William more thoroughly assessed by autism experts at this same hospital. Their assessment revealed that William had an IQ of 144—placing him squarely in the mentally gifted range. A formal speech and language assessment indicated that William was well over a year ahead in all areas. However, in the final report, it was noted that while William was alone with the examiner, he was unable to initiate or sustain conversations. He either stared off into the distance or interrupted the examiner to talk about off-topic subjects that were of interest to him—such as tornadoes, hurricanes, and earthquakes. When asked about friends, William made vague references to two girls who had moved away and was unable to recall any recent activities he had engaged in with them. Due mostly to his behavior in the room, the examiner assigned him a diagnosis of autism disorder because of his “communication and qualitative impairments in reciprocal social interaction.” Jacqueline was confused by the report. She wondered if the examiner had taken any time to actively engage William. She knew that William could be quite animated and talkative when adults took a liking to him.

Nevertheless, William’s parents went along with the diagnosis and so began their bewildering odyssey into the mental health field. At the behest of the specialist who assessed William, they secured a lawyer to sue the local regional center to obtain autism services. The regional center had unilaterally denied such services, claiming William needed to have been formally diagnosed as autistic prior to age three. It took $22,000 in legal fees to bring their case before a judge, who ordered William to be formally assessed by a medical doctor at the regional center. That doctor determined that William had full-blown autism and did indeed qualify for services. However, as the years unfolded, William’s parents had lingering doubts. They approached me when he was age eight.

I agreed to meet with William and to offer my clinical judgment. Within minutes of playing with William, I knew, unequivocally, that he was not “on the spectrum.” He was enthralled by the range of dart guns I had in my office and asked if we could play a World War II game. I heartily complied. William took turns being Hitler, then Stalin, mentioning how he was in command of millions of troops who followed his orders. When I playfully acted as one of his minions awaiting orders to shoot the enemy, William became delighted. He threw himself into the role of dictatorial commander and ordered me to shoot an imaginary enemy soldier. I did so, making loud machine-gun noises. William was emotionally beside himself. He quickly asked if he could be Stalin and I could be Hitler, and if I would shoot him. We reenacted this Hitler-shooting-Stalin scene over and over, with William pretending to be in the throes of death, each time using louder gurgling sounds and ever-so-dramatic, jerky body movements.

For me, William’s imaginativeness, as well as the emotional give-and-take in our pretend play interactions, was proof positive that it was folly to consider him autistic in any way.

Fast-forward to the present. William is now a high school student who is very active in student government. He is quite at ease with other teenagers who share his level of intellect. He continues to demonstrate the same thirst for knowledge that he had as a toddler. When classroom subjects interest him, his academic performance is stellar. When they don’t, William’s grades suffer. His report cards often contain peaks and valleys of As and Fs, which is immensely frustrating for his parents. His interests are not highly obscure and detail oriented, characteristic of autism, such as memorizing the names of dinosaurs or the serial numbers on Ford trucks. He is an abstract thinker who labors to understand issues more deeply. For instance, he has a complex understanding of different forms of government, and he is able to articulate the arguments for and against democratic, fascist, and oligarchical arrangements. This conceptual, philosophical way of acquiring knowledge tends not to be autism-friendly.

Granted, William is far more comfortable isolating himself and studying political geography and rock-and-roll memorabilia than he is hanging out at the mall. In addition, he can still explode emotionally when he is forced to switch activities, such as applying himself to his homework rather than researching Fender guitars or the geography of Iceland on the Internet. Moreover, he’ll only incorporate new food items into his diet when he has tried them at a fancy restaurant that doesn’t have kiddie foods such as pizza, hot dogs, or peanut butter sandwiches on the menu. However, these traits and behaviors don’t mean that he’s autism spectrum disordered. They reveal William to be a brainy, somewhat introverted, individualistically minded boy whose overexcitement for ideas and need for control cause problems with parents and peers.

As we shall see, boys with these traits and behaviors are often falsely diagnosed with autism spectrum disorder, especially when they are assessed at younger ages.

The early-diagnosis trap

True autism is a potentially very disabling neurological condition. Roy Richard Grinker, in his acclaimed book “Unstrange Minds,” masterfully documents the challenges he faced raising Isabel, his autistic daughter. At age two, she only made passing eye contact, rarely initiated interactions, and had trouble responding to her name in a consistent fashion. Her play often took the form of rote activities such as drawing the same picture repeatedly or rewinding a DVD to watch the same film clip over and over. Unless awakened each morning with the same utterance, “Get up! Get up!” Isabel became quite agitated. She tended to be very literal and concrete in her language comprehension. Expressions like “I’m so tired I could die” left her apprehensive about actual death. By age five, Isabel remained almost completely nonverbal.

When the signs of autism spectrum disorder are clear, as in Isabel’s case, early detection and intervention are essential to bolster verbal communication and social skills. The brain is simply more malleable when children are young. Isabel’s story in “Unstrange Minds” is a heroic testament to the strides a child can make when afforded the right interventions at the right time.

However, the earlier an evaluation is conducted, the greater the risk of a false diagnosis. Many toddlers can be autistic-like in their behavior when they are stressed. Sometimes the procedures used by experts to evaluate toddlers generate the sort of stress that leads a struggling, but otherwise normally developing, toddler to behavior that is autistic-like.

Nobody has made this point more clearly than the late Dr. Stanley Greenspan, the internationally recognized child psychiatrist who developed the popular Floortime approach to treating autism spectrum disordered kids. In his web-based radio show several years before his death in April 2010, he cited an alarming statistic. Of the two hundred autism assessment programs his team surveyed across the country, many of which were located in prestigious medical centers, only 10 percent emphasized the need to observe a child along with a parent or guardian for more than ten minutes as they spontaneously interacted together. He tended to observe children playing with a parent for forty-five minutes or more, waiting for choice points to engage a child to determine if he or she was capable of more sustained eye contact, elaborate verbalizations, or shared emotional reactions. Dr. Greenspan believed that these conditions of safety and sensitive interaction were essential in order to obtain an accurate reading of a child’s true verbal and social skills.

For a sizable percentage of toddlers who don’t transition well to new surroundings, freeze up with strangers, or temporarily dread being apart from a parent, the formal nature of a structured autism assessment can lead to their becoming mute, hiding under a table, avoiding eye contact, hand flapping, or exhibiting any number of other self-soothing behaviors that get misinterpreted as autistic-like. Trained professionals are supposed to conduct autism assessments in a standardized way. This is clinical jargon for being fairly neutral in one’s approach to the child. This might involve an examiner assuming a seating position that requires a child to turn his or her head ninety degrees to directly look at the examiner when his or her name is called. If the child fails to look up and make direct eye contact with the examiner after his or her name is called aloud several times, the child is considered to be exhibiting autism red-zone behavior. Yet many distressed or slow-to-warm toddlers will only respond to their name if an unfamiliar adult strives to be warm, engaging, and nonthreatening—not just neutral.

It is these autistic-like situational reactions of struggling toddlers during formal testing conditions that make a false diagnosis a real possibility. A 2007 University of North Carolina at Chapel Hill study found that over 30 percent of children diagnosed as autistic at age two no longer fit the diagnosis at age four. Several years ago, data supplied by parents of over seventy-eight thousand three- to seventeen-year-olds, as part of a National Survey of Children’s Health, discovered that nearly 40 percent had a previous, but not a current, diagnosis of autism spectrum disorder.

There are other reasons why a sizable percentage of toddlers get erroneously diagnosed with autism spectrum disorder. Up to one in five two-year-olds are late talkers. They fall below the fifty-word expressive-vocabulary threshold and appear incapable of stringing together two- and three-word phrases. This sort of irregular language development is one of the hallmarks of early autism. Yet it is notoriously difficult to distinguish between toddlers with autism spectrum disorder and those who are afflicted with delayed language development. The situation is further complicated by the fact that toddlers with delayed language development tend to share other features in common with autism spectrum children. Scientific findings at the famed Yale Child Study Center have shown that toddlers with delayed language development are almost identical to their autism spectrum disordered counterparts in their use of eye contact to gauge social interactions, the range of sounds and words they produce, and the emotional give-and-take they are capable of. Consequently, many toddlers who simply don’t meet standard benchmarks for how quickly language should be acquired and social interactions mastered are in the autism red zone.

Expanding autistic phenomena to include picky eating and tantrums only amounts to more confusion when applied to toddlers. The percentage of young children in the United States with poor appetites and picky eating habits is so high that experts writing in the journal Pediatrics in 2007 commented, “It could reasonably be said that eating-behavior problems are a normal feature of toddler life.” Tantrums also are surprisingly frequent and intense during the toddler years. Dr. Gina Mireault, a behavioral sciences professor at Johnson State College in Vermont, studied children from three separate local preschools. She discerned that toddlers had tantrums, on average, once every few days. Almost a third of the parents surveyed considered their child’s tantrum behavior to be distressing or disturbing.

With the push to screen for and detect autism spectrum disorder at progressively younger ages, the risk is greater that late-talking, picky-eating, tantrum-throwing, transition-resistant toddlers will be misperceived as potentially autistic—especially if an evaluation is conducted in which the child is not sensitively engaged and put at ease. The risk is more acute, as I will soon illustrate, if this toddler is likely to develop into an introverted, cognitively gifted boy who tends to be single-minded and willful in his approach to life learning. Even more basic than that, if we don’t have a firm grasp of gender differences in how young children communicate and socialize, we can mistake traditional masculine behavior for high-functioning autism.

How boys communicate and socialize

A book I return to every so often is Eleanor Maccoby’s “The Two Sexes.” Her descriptions of boys’ and girls’ different speech styles jive with what I see daily in my office. She maintains, and I agree, that boys’ speech, on average, tends to be more egoisticthan girls’. Boys are more apt to brag, interrupt, and talk over others, and ignore commands or suggestions. They are more inclined to grandstand and “hold court,” trying to impress listeners with all that they know. They seem to be less socially attuned than girls. They are less likely to scan the faces and body language of others for cues on whether they should stop talking and start listening—for basic social sensitivity reasons.

Simon Baron-Cohen, the Cambridge University professor who popularized the extreme-male-brain theory of autism, would say that boys’ speech is more egoistic because, overall, boys tend to be less empathic than girls. He backs this up with abundant scientific evidence. Putting yourself in someone else’s shoes to figure out what they might be feeling comes more naturally to girls. Girls are simply more inclined to read a person’s facial expressions in order to make sure that they are coming across sensitively. Faces tend to be sources of social feedback for girls in ways that they are not for boys. Dr. Baron-Cohen’s research team has discovered that even at birth, female infants will look longer at faces than male infants and prolong mutual eye gazing.

Many boys just get perplexed when you try to empathize with them. As an example, I recently had the following interaction with Alan, an eight-year-old:

Alan: In my soccer game over the weekend, the other forwards on my team never passed to me. I was so mad.

Dr. Gnaulati: You were mad because your teammates didn’t pass to you, eh.

Alan: Why are you repeating what I just said? Didn’t you hear me?

This interaction with Alan captures how for many boys, grasping the literal content of their verbalizations matters more than “feeling understood.” Appearing attentive, asking probing questions, and reflecting back what someone is saying may be the empathic glue that cements a friendship for the average female. However, for the average male, following along with and responding to the literal content of what they are saying is what’s deemed valuable. A friend is someone who shares your interests and with whom you can have detailed discussions about these interests.

Watch boys at a sleepover and you’ll quickly realize that they need a joint activity to buttress social interaction and verbal dialogue. If that joint activity is a videogame like Red Dead Redemption, the discussion will be peppered with pragmatic exchanges of information about how best to tame horses, free someone who has been kidnapped, or locate animal pelts. Without a joint activity that taps into their preexisting knowledge about that activity, boys are often at a loss for discussion. There are long silences. Eye contact is avoided. Bodies become more wiggly.

Watch girls at a sleepover and any shared activity they engage in is often secondary to the pleasure they seem to derive from just hanging out and talking.

The stereotype of boys as logical, inflexible, and businesslike in their communication habits is more than just a stereotype. A recent massive study out of the University of Florida involving fifty-four hundred children in the United States ages eight to sixteen indicates that twice as many boys as girls fit this thinking-type temperament. Conversely, twice as many girls as boys fit the feeling-type temperament— tactful, friendly, compassionate, and preferring emotion over logic.

Many boys feel compelled to be logical and exact in their use of language. They withdraw and shut down around people who use language more loosely. A glaring example of this was shown to me recently by a fourteen-year-old client named Jordan. His parents brought him in for therapy because he was racking up school detentions for being rude to teachers. Jordan secretly confessed to me that his English teacher must be dumb because she referred to certain assignments as “homework” when she allowed them to be completed in class. She should have renamed them “schoolwork,” he said, because they were being completed at school. In twenty-five years of therapy practice, I’ve never known a girl to make such a comment.

As educated people, we don’t want to believe in overarching differences in communication styles between the sexes. When I was in college in the 1980s and ’90s, “essentialism” was a dirty word. To believe that males and females might be different in essential ways was akin to admitting that you were unenlightened. There’s still a pervasive sense in our culture that to be educated is to be gender-blind, and there is something of a taboo against voicing aloud explanations for a child’s behavior in terms of his or her gender. If you don’t believe me, try uttering some version of the following statements at your son’s next parent-teacher conference: Jamal is so logical and brusque when he talks. I know he needs all our help to ease up. But these are traditional masculine behaviors, after all, and we might need to accept him more for who he is. Or, Billy overtalks and really needs an audience, especially when he has a new favorite hobby or interest. He needs to be a better listener. But he’s not unlike a lot of boys I know.

It’s this public discomfort with discussing children’s gendered behavior that gets many traditionally masculine boys inappropriately labeled as high-functioning autistic. Poor eye contact, long-winded monologues about one’s new favorite topic, being overly serious and businesslike, appearing uninterested in other’s facial expressions, and restricting friendships to those who share one’s interests, may all be signs of Asperger’s syndrome or high-functioning autism. However, these same traits typify boys who are traditionally masculine in their behavior. Parents somehow have to ask the uncomfortable question in the doctor’s office: Is he high-functioning autistic or really a more masculine-identified boy? If it’s the latter, what a boy may need is some combination of acceptance and personal and professional help to finesse his social skills over time—not an incorrect diagnosis and unnecessary medical treatment.

Brainy, introverted boys beware

Let’s return to William. With all respect to the good doctors at the university-based institute who evaluated him, they were not up on the literature on mental giftedness. We know this because William manifested certain brainy, mentally gifted traits that can look autistic-like to the untrained eye, but aren’t. Take his tendency to burrow deep into a topic and crave more and more information on it. There was his Pompeii phase, then his Titanic phase. He just had to learn all that he possibly could about these topics. He talked the ear off of anybody who would listen to him about them. On the face of it, William’s obsessions appeared autistic-like. However, it is the enthusiasm with which he shared his interests with others that distinguishes William as brainy and mentally gifted, rather than autistic in any way. Remember, at preschool, he was sometimes a regular pied piper, amassing a following. Other kids were initially drawn to him when he held court or orchestrated his Titanic play. William lit up emotionally when he commanded the attention of the preschoolers who gathered around him.

When highly restricted interests are shared with relatively little spontaneity and enthusiasm, in ways that fail to entice children to come hither to listen and play—this is when we should suspect autism spectrum disorder. The same is true when a kid talks without interruption about a very technical topic, such as dinosaur names or bus schedules, seemingly indifferent to whether the listener congratulates him for his encyclopedic knowledge or is peeved by the lecture.

Another characteristic of William’s that is evidence of mental giftedness and not autism spectrum disorder is how fluid and changeable his areas of interest could be. As he got older, William became fascinated by subjects as diverse as world geography, ancient history, the lives of rock stars (especially the Beatles), and vintage guitars. He approached his new areas of interest with the same degree of mental engrossment that he had approached his old ones, regardless of how unrelated the new ones were to the old ones. Autism spectrum disordered children tend to hold steadfast to their odd topics of interest over time and not readily substitute one for another.

One of the drawbacks to early screening and detection of high-functioning autism is that small children’s cognitive development isn’t sufficiently mature enough to judge what their sense of humor is like. Often it is a sense of humor that separates true cases of mild autism from mental giftedness. Mildly autistic kids often don’t really comprehend irony, sarcasm, and absurdity. Mentally gifted kids, on the other hand, often thrive on irony, sarcasm, and absurdity. This distinction was brought home to me recently in an interaction with an intellectual eleven-year-old boy named Michael. His lengthy, detailed discourses on planets and the solar system made his parents wonder whether he might have Asperger’s syndrome. One day, after meeting with his mother briefly for a check-in, I went out to the waiting room and warmly greeted Michael: “Speak of the devil, we were just talking about you.” Michael came back to the office and, as he picked up a rubber sword to engage me, jokingly warned, “I am the devil, and you will get burned.” I knew right then and there that Asperger’s was completely out of the question.

Highly intelligent boys who happen to be introverted by temperament are probably the subpopulation of kids who are most likely to be erroneously labeled autistic. In her provocatively titled Psychology Today article “Revenge of the Introvert,” Laurie Helgoe, a self-described card-carrying introvert, captures a key personality characteristic of introverts: “[They] like to think before responding—many prefer to think out what they want to say in advance—and seek facts before expressing opinions.” Introverted, highly intelligent boys may appear vacant and nonresponsive when asked a question like “What is your favorite animal?” Yet in their minds, they may be deeply and actively processing copious amounts of information on types and defining features of animals and zeroing in on precise words to use to articulate their complex thoughts. Thirty seconds, a minute, or even more time may pass before an answer is supplied. In the meantime, the listener might wonder if the boy is deaf or completely self-absorbed.

According to Laurie Helgoe: “Introverts seek time alone because they want time alone.” Brainy, introverted boys may cherish and look forward to alone time, which allows them the opportunity to indulge their intellectual appetites full throttle, amassing knowledge through reading or Internet searches. Solitude creates the time and space they need to totally immerse themselves in their preferred interests. They may get more turned on by studying ideas, pursuing science projects, or by solving math problems than by conversing with people.

In our extroverted culture, where being a “team player” and a “people person” are seen as linchpins of normalcy, the notion that a brainy, introverted boy might legitimately prefer the world of ideas over the world of people is hard for most people to accept. Parents of such boys may feel terribly uneasy about their tendency to want to be alone and try to push their sons to be sociable and to make more friends. But if you get to know such boys, they would much rather be alone reading, writing, or pursuing projects that stimulate their intellect than be socializing with peers who are not their intellectual equals. However, once they come into contact with a kindred spirit, someone who is a true intellectual equal with whom they can share the fullness of their ideas, that person just might become a lifelong friend. Around such kindred spirits, brainy, introverted boys can perk up and appear more extroverted and outgoing, wanting to talk as well as to listen. With people who share their interests, especially people who possess equal or greater knowledge in these areas, brainy, introverted boys can display quite normal social skills.

My way or no way: autonomy seeking, not autism

I’d like to engage the reader in a thought-provoking exercise. I’m going to list a collection of behaviors. As you peruse them, ask yourself if these behaviors are indicative of typical willful male toddlers or of possible autism at this age. Remember, the toddler years are from approximately age one to three.

Doesn’t look when you call their name, even if they seem to hear other sounds
Doesn’t look you in the eye much or at all
Doesn’t notice when you enter or leave a room
Seems to be in their own world
Doesn’t look where you do or follow your finger when you point to something

Leads you by the hand to tell you what they want
Can’t do simple things you ask them to do
Has a lot of tantrums
Prefers to play alone
Wants to always hold a certain object, such as a flashlight Doesn’t play with toys in the usual way

It may surprise the reader to learn that I obtained this list of behaviors from a Consumer Reports health-related article titled “What Are the Symptoms of Autism?” If this exercise left you thinking that these behaviors might be characteristic of both willful male toddlers and autistic children, that’s commendable. This means that you have more than a passing familiarity with early childhood development. It also means that you are keenly aware of how toddler issues can get misconstrued as autistic tendencies.

The glee on the faces of toddlers upon discovering that they can propel themselves away from caregivers and into the world beyond— with the power of their own limbs—says it all. During the first year of life, they were relatively helpless. They were at the complete mercy of caregivers to gauge what they needed. Now their fast-evolving fine-and gross-motor abilities are being put to full use in exploring their surroundings. There is fire in their bellies. They insist on having personal control over what they get to see, hear, touch, smell, and taste and for how long. This is what developmental psychologists call the “need for autonomy” that kicks in during toddlerhood. The word parents tend to use is “willfulness.” There is a world of sensory delight out there for toddlers to discover and sample, and they want nothing to get in their way.

Male toddlers advance at a faster rate than the opposite sex in their gross-motor development and visual-spatial skills. The science is there. Generally speaking, boys are more physically capable of exploring their environments than girls. When they do, objects are likely to be the object of their exploration. Little boys, especially those with strong visual-spatial intelligence, can appear as though they’ve entered a trance when they stare at, squeeze, lick, toss and fetch, arrange, stack, and knock down blocks—only to do it all over again. We forget how immersion in an activity, and repetition of it, can lead to an experience of mastery. Lining up trains in identical order, making the same sounds, and pulling them with the same force can rekindle the same feeling of mastery that was felt the first time this activity went well. Not all repetitiveness and needs for sameness speak to autistic tendencies. When a toddler appears driven to use his body effectively in the accomplishment of a task and to further an experience of mastery, it’s unlikely that he’s on the spectrum no matter how repetitive the task becomes—particularly if that toddler shows self-pride and wants others to share in the excitement of it all, even in quiet and subdued ways.

Boys’ level of engrossment in discovering and manipulating objects can lead them to be oblivious to their surroundings. They may not look up when their name is called. They may appear unconcerned whether you’re in the room or not. Self-absorption while studying objects is expectable behavior for male toddlers, especially for those on the upper end of the bell curve on visual-spatial intelligence.

Parents and educators shouldn’t assume the worst when male toddlers play alone. Research shows that boys are far more likely to engage in solitary play than girls at this age. Many little boys are satisfied playing alone or quietly alongside someone else, lining up toy trains, stacking blocks, or engaging in a range of sensorimotor play activities. It is not until about age four or five that boys are involved in associative play to the same extent as girls. That’s the kind of play where there’s verbal interaction and give-and-take exchanges of toys and ideas.

The difference between a relatively typical male toddler immersed in solitary object play and one who shows early signs of autistic behavior can be subtle. Typically developing male toddlers are more apt to experience periodic separation anxiety. They suddenly wonder where Mommy is. Needing Mommy in these moments takes precedence over the activity in which they were absorbed. Sometimes visually checking in and receiving a reassuring glance back from Mommy is enough. Sometimes more is needed, like approaching her for a hug or a pat on the back. This inspires confidence that Mom will be available if and when needed. The toddler can then go across the room and pick up where he left off playing. This “emotional pit stop” behavior is less apparent with toddlers on the spectrum.

Mentally gifted boys are often perfectionists. Their projects need to be done just right, and they will continue to work on a project until it is exactly what they want. During toddlerhood, when early signs of perfectionism are mixed with regular needs for autonomy, the combination can make a child look very controlling. A cognitively advanced three-year-old boy who is also a perfectionist might spend hours arranging and rearranging, stacking and restacking blocks to construct a castle that he feels needs to be flawless if he’s to be satisfied. Attempts to get his attention, have him come to the kitchen for a snack, or put the blocks aside to get ready for bed are ignored or resisted. When such demands are issued suddenly, without forewarning, and instant compliance is expected, this is the emotional equivalent, for the toddler, of someone purposely tripping and badly injuring a front-place marathon runner right at the finish line. A tantrum is a distinct possibility. The child is in emotional pain due to being unable to prolong and achieve an experience of mastery.

Tantrums during the toddler years are, of course, commonplace. Under normal family circumstances, when a toddler’s maturation is right on schedule, parents can expect a tantrum from their three-to five-year-old once every few days. That was the conclusion of Dr. Gina Mireault’s study, cited earlier. Her research also revealed that the reason top ranked by parents as triggering a toddler’s tantrum is this: “Denial of a request/not getting his or her way.” Most tantrums are triggered by parents directly confronting kids’ assertions of autonomy or by kids’ need to have personal control over what they get to see, hear, touch, smell, and taste, and for how long. Tantrums can be exacerbated by fatigue and hunger. Toddlers have different temperaments, and this influences the frequency, intensity, and duration of tantrums. But in general, tantrums occur because a toddler is denied ice cream before dinner, for example, or is prevented from grabbing Grandma’s expensive Moorcroft pottery dish or insists on watching one more show when it’s bedtime—or any such expectable parental challenge to their need to prolong a pleasurable activity or independently exercise sensorimotor mastery.

The tantrums of autism spectrum kids are less likely to be of the autonomy-assertion or mastery-seeking variety. Their tantrums more often than not reflect sensory overload. They may scream and writhe around on the floor because they are in physical pain due to their nervous system being bombarded by an intolerable level of stimulation. The sights and sounds at the mall when their family is shopping for holiday gifts may put them over the top. The buzz from and brightness of overhead lights might be a trigger. Rituals and routines are relied on to keep sensory stimulation at manageable levels. Tantrums may signal a need to keep a ritual or routine exactly the way it was to protect the kid from sensory overload.

Sometimes what appears to be an autistic-like tantrum is really what Dr. Stanley Greenspan, the world-renowned child psychiatrist, calls “sensory craving.” This applies to toddlers whose ability to self-regulate their feelings while they’re in the act of exploring their environments is underdeveloped:

Many children show a pattern we call “sensory craving,” where they’re running around the house trying to get more sensation into their system, whether it’s staring at fans, or bumping into things or touching everything or just shifting from one toy to another in a seemingly aimless way, or just spinning around and jumping around or shaking their arms and legs in seemingly disjointed ways. These all look like terrible symptoms and they scare parents and they scare some professionals as well, understandably so. But they’re often signs of sensory craving—a child wants more sensory input, but doesn’t know how to do it in an organized social way.

These are toddlers who Dr. Greenspan thinks need abundant “sensory meaningful” interactions with parents and care providers to help them become more self-composed over time. This could amount to matching the child’s energy and activity level in a fun airplane-ride game. Scooping him up, asking him to point his fist in the direction in which he wants to be flown, with a thumbs-up for faster and a thumbs-down for slower, would be an example of a sensory-meaningful interaction that still honors his need for autonomy.

Temper outbursts and quirky behavior around food preferences are widespread among autism spectrum children. But the same can be said of toddlers in general. It’s important to have a sense of perspective regarding the pervasiveness of toddlers’ habit of latching onto preferred foods and rejecting new offerings. A survey of more than three thousand households with infants and toddlers conducted by nutrition experts at the University of Tennessee–Knoxville indicates that a whopping 50 percent of two-year-olds are considered picky eaters by their caregivers. These nutritionists believe the numbers are so high because mothers are not persistent enough in introducing new foods in ways that ensure they’ll eventually be eaten: “When offering a new food, mothers need to provide many more repeated exposures (e.g., eight to 15 times) to enhance acceptance of that food than they currently do.”

Let’s call this the “eight-to-fifteen-times rule.” If a toddler reacts with revulsion, aggressively throwing dishes on the floor or refusing to eat each time a new food item is introduced after eight to fifteen separate attempts, chances are that he or she is a picky eater. This is particularly true if, in the process, the parent stayed calm and conveyed confidence that the new food item was good to eat—not being too insistent on the one hand, or tentative, on the other.

But certainly not all picky eaters are that way because they are on the spectrum. Autism spectrum children who are picky eaters often have odd food preferences, such as only eating foods that are yellow-colored. Their reactions after repeated exposure to new foods frequently remain acute or become even more blustery. It’s not about power struggles and control. A new food item may literally assault their senses. The smell, look, and texture of that food may induce a type of sensory revulsion and disgust. They can’t be around it. Either it goes or the kid does—perhaps agitatedly running off.

Off the spectrum

The younger in age a kid is when professionals screen for milder forms of autism, the greater the risk a struggling kid will be misperceived as a disordered one. A vast number of toddlers present in the doctor’s office with a hodgepodge of social and emotional difficulties, such as poor eye contact, overactivity and underactivity, tantrums, picky eating, quirky interests, or social awkwardness. These phenomena need not be seen as telltale signs of autism spectrum disorder. Sometimes they are merely evidence of a perfect storm of off-beat events in social and emotional development mixed with difficult personality traits—with the upshot that the kid, for the time being, is very out of sorts.

When we mistake a brainy, introverted boy for an autism spectrum disordered one, we devalue his mental gifts. We view his ability to become wholeheartedly engrossed in a topic as a symptom that needs to be stamped out, rather than a form of intellectualism that needs to be cultivated. Boys like William don’t need to be channeled into unwanted and unnecessary social-skills classes to obtain formal instruction on how to start and sustain normal conversations. They don’t need to be prodded to be more sociable with the neighborhood kid whose mind works completely differently from theirs. They need unique school programs that cater to the mentally gifted in which others will not be chagrined by their intense love for ideas and where they have a shot at making true friends and therefore have the opportunity to feel truly sociable.

Excerpted from “Back to Normal: Why Ordinary Childhood Behavior Is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder,” by Enrico Gnaulati, Ph.D. (Beacon Press, 2013). Reprinted with permission from Beacon Press.

Enrico Gnaulati is a clinical psychologist who specializes in working with children and families. He is a sought-after public speaker on issues of childhood development and has been widely published in professional medical journals and magazines.

Misdiagnosis and Dual Diagnosis of Gifted Children

Author James T. Webb, Edward R. Amend, Nadia E. Webb, Jean Goerss, Paul Beljan, F. Richard Olenchak Citation Abstracted from: Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, bipolar, OCD, Asperger’s, depression, and other disorders. (2004) Scottsdale: Great Potential Press. Available from the publisher.

Misdiagnosis and Dual Diagnosis of Gifted Children

Authors: James T. Webb, Edward R. Amend, Nadia E. Webb, Jean Goerss, Paul Beljan, F. Richard Olenchak

Citation:  Abstracted from Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, bipolar, OCD, Asperger’s, depression, and other disorders. (2004) Scottsdale: Great Potential Press. Available from the publisher.

Many gifted and talented children (and adults) are being mis-diagnosed by psychologists, psychiatrists, pediatricians, and other health care professionals. The most common mis-diagnoses are: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (OD), Obsessive Compulsive Disorder (OCD), and Mood Disorders such as Cyclothymic Disorder, Dysthymic Disorder, Depression, and Bi-Polar Disorder. These common mis-diagnoses stem from an ignorance among professionals about specific social and emotional characteristics of gifted children which are then mistakenly assumed by these professionals to be signs of pathology.

In some situations where gifted children have received a correct diagnosis, giftedness is still a factor that must be considered in treatment, and should really generate a dual diagnosis. For example, existential depression or learning disability, when present in gifted children or adults, requires a different approach because new dimensions are added by the giftedness component. Yet the giftedness component typically is overlooked due to the lack of training and understanding by health care professionals (Webb & Kleine, 1993).

Despite prevalent myths to the contrary, gifted children and adults are at particular psychological risk due to both internal characteristics and situational factors. These internal and situational factors can lead to interpersonal and psychological difficulties for gifted children, and subsequently to mis-diagnoses and inadequate treatment.

Internal Factors
First, let me mention the internal aspects (Webb, 1993). Historically, nearly all of the research on gifted individuals has focused on the intellectual aspects, particularly in an academic sense. Until recently, little attention has been given to personality factors which accompany high intellect and creativity. Even less attention has been given to the observation that these personality factors intensify and have greater life effects when intelligence level increases beyond IQ 130 (Silverman, 1993; Webb, 1993; Winner, 2000).

Perhaps the most universal, yet most often overlooked, characteristic of gifted children and adults is their intensity (Silverman, 1993; Webb, 1993). One mother described it succinctly when she said, “My child’s life motto is that anything worth doing is worth doing to excess.” Gifted children — and gifted adults– often are extremely intense, whether in their emotional response, intellectual pursuits, sibling rivalry, or power struggles with an authority figure. Impatience is also frequently present, both with oneself and with others. The intensity also often manifests itself in heightened motor activity and physical restlessness.

Along with intensity, one typically finds in gifted individuals an extreme sensitivity–to emotions, sounds, touch, taste, etc. These children may burst into tears while watching a sad event on the evening news, keenly hear fluorescent lights, react strongly to smells, insist on having the tags removed from their shirts, must touch everything, or are overly reactive to touch in a tactile-defensive manner.

The gifted individual’s drive to understand, to question, and to search for consistency is likewise inherent and intense, as is the ability to see possibilities and alternatives. All of these characteristics together result in an intense idealism and concern with social and moral issues, which can create anxiety, depression, and a sharp challenging of others who do not share their concerns.

Situational Factors
Situational factors are highly relevant to the problem of mis-diagnosis (Webb, 1993). Intensity, sensitivity, idealism, impatience, questioning the status quo–none of these alone necessarily constitutes a problem. In fact, we generally value these characteristics and behaviors–unless they happen to occur in a tightly structured classroom, or in a highly organized business setting, or if they happen to challenge some cherished tradition, and gifted children are the very ones who challenge traditions or the status quo.

There is a substantial amount of research to indicate that gifted children spend at least one-fourth to one-half of the regular classroom time waiting for others to catch up. Boredom is rampant because of the age tracking in our public schools. Peer relations for gifted children are often difficult (Webb, Meckstroth and Tolan, 1982; Winner, 2000), all the more so because of the internal dyssynchrony (asynchronous development) shown by so many gifted children where their development is uneven across various academic, social, and developmental areas, and where their judgment often lags behind their intellect.

Clearly, there are possible (or even likely) problems that are associated with the characteristic strengths of gifted children. Some of these typical strengths and related problems are shown in Table 1.

Table 1: Possible Problems That May be Associated with Characteristic Strengths of Gifted Children

Strengths Possible Problems
Acquires and retains information quickly. Impatient with slowness of others; dislikes routine and drill; may resist mastering foundational skills; may make concepts unduly complex.
Inquisitive attitude, intellectual curiosity; intrinsic motivation; searching for significance. Asks embarrassing questions; strong-willed; resists direction; seems excessive in interests; expects same of others.
Ability to conceptualize, abstract, synthesize; enjoys problem-solving and intellectual activity. Rejects or omits details; resists practice or drill; questions teaching procedures.
Can see cause–effect relations. Difficulty accepting the illogical-such as feelings, traditions, or matters to be taken on faith.
Love of truth, equity, and fair play. Difficulty in being practical; worry about humanitarian concerns.
Enjoys organizing things and people into structure and order; seeks to systematize. Constructs complicated rules or systems; may be seen as bossy, rude, or domineering.
Large vocabulary and facile verbal proficiency; broad information in advanced areas. May use words to escape or avoid situations; becomes bored with school and age-peers; seen by others as a “know it all.”
Thinks critically; has high expectancies; is self-critical and evaluates others. Critical or intolerant toward others; may become discouraged or depressed; perfectionistic.
Keen observer; willing to consider the unusual; open to new experiences. Overly intense focus; occasional gullibility.
Creative and inventive; likes new ways of doing things. May disrupt plans or reject what is already known; seen by others as different and out of step.
Intense concentration; long attention span in areas of interest; goal-directed behavior; persistence. Resists interruption; neglects duties or people during period of focused interests; stubbornness.
Sensitivity, empathy for others; desire to be accepted by others. Sensitivity to criticism or peer rejection; expects others to have similar values; need for success and recognition; may feel different and alienated.
High energy, alertness, eagerness; periods of intense efforts. Frustration with inactivity; eagerness may disrupt others’ schedules; needs continual stimulation; may be seen as hyperactive.
Independent; prefers individualized work; reliant on self. May reject parent or peer input; non-conformity; may be unconventional.
Diverse interests and abilities; versatility. May appear scattered and disorganized; frustrations over lack of time; others may expect continual competence.
Strong sense of humor. Sees absurdities of situations; humor may not be understood by peers; may become “class clown” to gain attention.

Adapted from Clark (1992) and Seagoe (1974)

Lack of understanding by parents, educators, and health professionals, combined with the problem situations (e.g., lack of appropriately differentiated education) leads to interpersonal problems which are then mis-labeled, and thus prompt the mis-diagnoses. The most common mis-diagnoses are as follows.

Common Mis-Diagnoses
ADHD and Gifted. Many gifted children are being mis-diagnosed as Attention Deficit Hyperactivity Disorder (ADHD). The gifted child’s characteristics of intensity, sensitivity, impatience, and high motor activity can easily be mistaken for ADHD. Some gifted children surely do suffer from ADHD, and thus have a dual diagnosis of gifted and ADHD; but in my opinion, most are not. Few health care professionals give sufficient attention to the words about ADHD in DSM-IV(1994) that say “…inconsistent with developmental level….” The gifted child’s developmental level is different (asynchronous) when compared to other children, and health care professionals need to ask whether the child’s inattentiveness or impulsivity behaviors occur only in some situations but not in others (e.g., at school but not at home; at church, but not at scouts, etc.). If the problem behaviors are situational only, the child is likely not suffering from ADHD.

To further complicate matters, my own clinical observation suggests that about three percent of highly gifted children suffer from a functional borderline hypoglycemic condition. Silverman (1993) has suggested that perhaps the same percentage also suffer from allergies of various kinds. Physical reactions in these conditions, when combined with the intensity and sensitivity, result in behaviors that can mimic ADHD. However, the ADHD-like symptoms in such cases will vary with the time of day, length of time since last meal, type of foods eaten, or exposure to other environmental agents.

Oppositional Defiant Disorder and Gifted. The intensity, sensitivity, and idealism of gifted children often lead others to view them as “strong-willed.” Power struggles with parents and teachers are common, particularly when these children receive criticism, as they often do, for some of the very characteristics that make them gifted (e.g., “Why are you so sensitive, always questioning me, trying to do things a different way,” etc.).

Bi-Polar and other Mood Disorders and Gifted. Recently, I encountered a parent whose highly gifted child had been diagnosed with Bi-Polar Disorder. This intense child, whose parents were going through a bitter divorce, did indeed show extreme mood swings, but, in my view, the diagnosis of Bi-Polar Disorder was off the mark. In adolescence, or sometimes earlier, gifted children often do go through periods of depression related to their disappointed idealism, and their feelings of aloneness and alienation culminate in an existential depression. However, it is not at all clear that this kind of depression warrants such a major diagnosis.

Obsessive-Compulsive Disorder and Gifted. Even as preschoolers, gifted children love to organize people and things into complex frameworks, and get quite upset when others don’t follow their rules or don’t understand their schema. Many gifted first graders are seen as perfectionistic and “bossy” because they try to organize the other children, and sometimes even try to organize their family or the teacher. As they grow up, they continue to search intensely for the “rules of life” and for consistency. Their intellectualizing, sense of urgency, perfectionism, idealism, and intolerance for mistakes may be misunderstood to be signs of Obsessive-Compulsive Disorder or Obsessive-Compulsive Personality Disorder. In some sense, however, giftedness is a dual diagnosis with Obsessive-Compulsive Personality Disorder since intellectualization may be assumed to underlie many of the DSM-IV diagnostic criteria for this disorder.

Dual Diagnoses
Learning Disabilities and Giftedness. Giftedness is a coexisting factor, to be sure, in some diagnoses. One notable example is in diagnosis and treatment of learning disabilities. Few psychologists are aware that inter-subscale scatter on the Wechsler intelligence tests increases as a child’s overall IQ score exceeds 130. In children with a Full Scale IQ score of 140 or greater, it is not uncommon to find a difference of 20 or more points between Verbal IQ and Performance IQ (Silverman, 1993; Webb & Kleine, 1993; Winner, 2000). Most clinical psychologists are taught that such a discrepancy is serious cause for concern regarding possible serious brain dysfunction, including learning disabilities. For highly gifted children, such discrepancy is far less likely to be an indication of pathological brain dysfunction, though it certainly would suggest an unusual learning style and perhaps a relative learning disability.

Similarly, the difference between the highest and lowest scores on individual subscales within intelligence and achievement tests is often quite notable in gifted children. On the Wechsler Intelligence Scale for Children – III, it is not uncommon to find subscale differences greater than seven scale score points for gifted children, particularly those who are highly gifted. These score discrepancies are taken by most psychologists to indicate learning disabilities, and in a functional sense they do represent that. That is, the levels of ability do vary dramatically, though the range may be “only” from Very Superior to Average level of functioning. In this sense, gifted children may not “qualify” for a diagnosis of learning disability, and indeed some schools seem to have a policy of “only one label allowed per student,” and since this student is gifted, he/she can not also be considered learning disabled. However, it is important for psychologists to understand the concept of “asynchronous development” (Silverman, 1993), and to appreciate that most gifted children show such an appreciable, and often significant, scatter of abilities.

Poor handwriting is often used as one indicator of learning disabilities. However, many and perhaps most gifted children will show poor handwriting. Usually this simply represents that their thoughts go so much faster than their hands can move, and that they see little sense in making writing an art form when its primary purpose is to communicate (Webb & Kleine, 1993; Winner, 2000).

Psychologists must understand that, without intervention, self-esteem issues are almost a guarantee in gifted children with learning disabilities as well as those who simply have notable asynchronous development since they tend to evaluate themselves based more on what they cannot do rather than on what they are able to do. Sharing formal ability and achievement test results with gifted children about their particular abilities, combined with reassurance, can often help them develop a more appropriate sense of self-evaluation.

Sleep Disorders and Giftedness. Nightmare Disorder, Sleep Terror Disorder, and Sleepwalking Disorder appear to be more prevalent among gifted children, particularly boys. It is unclear whether this should be considered a mis-diagnosis or a dual diagnosis. Certainly, parents commonly report that their gifted children have dreams that are more vivid, intense, and more often in color, and that a substantial proportion of gifted boys are more prone to sleepwalking and bed wetting, apparently related to their dreams and to being more soundly (i.e., intensely) asleep. Such concordance would suggest that giftedness may need to be considered as a dual diagnosis in these cases, or at least a factor worthy of consideration since the child’s intellect and sense of understanding often can be used to help the child cope with nightmares.

A little known observation concerning sleep in gifted individuals is that about twenty percent of gifted children seem to need significantly less sleep than other children, while another twenty percent appear to need significantly more sleep than other children. Parents report that these sleep patterns show themselves very early in the child’s life, and long-term follow up suggests that the pattern continues into adulthood (Webb & Kleine, 1993; Winner, 2000). Some highly gifted adults appear to average comfortably as few as two or three hours sleep each night, and they have indicated to me that even in childhood they needed only four or five hours sleep.

Multiple Personality Disorders and Giftedness. Though there is little formal study of giftedness factors within MPD, there is anecdotal evidence that the two are related. The conclusion of professionals at the Menninger Foundation was that most MPD patients showed a history of childhood abuse, but also high intellectual abilities which allowed them to create and maintain their elaborate separate personalities (W. H. Smith personal communication, April 18, 1996).

Relational Problems and Giftedness. As one mother told me, “Having a gifted child in the family did not change our family’s lifestyle; it simply destroyed it!” These children can be both exhilarating and exhausting. But because parents often lack information about characteristics of gifted children, the relationship between parent and child can suffer. The child’s behaviors are seen as mischievous, impertinent, weird, or strong-willed, and the child often is criticized or punished for behaviors that really represent curiosity, intensity, sensitivity, or the lag of judgment behind intellect. Thus, intense power struggles, arguments, temper tantrums, sibling rivalry, withdrawal, underachievement, and open flaunting of family and societal traditions may occur within the family.

“Impaired communication” and “inadequate discipline” are specifically listed in the DSM-IV (1994) as areas of concern to be considered in a diagnosis of Parent-Child Relational Problems, and a diagnosis of Sibling Relational Problem is associated with significant impairment of functioning within the family or in one or more siblings. Not surprisingly, these are frequent concerns for parents of gifted children due to the intensity, impatience, asynchronous development, and lag of judgment behind intellect of gifted children.

Health care professionals could benefit from increased knowledge concerning the effects of a gifted child’s behaviors within a family, and thus often avoid mistaken notions about the causes of the problems. The characteristics inherent within gifted children have implications for diagnosis and treatment which could include therapy for the whole family, not in the sense of “treatment,” but to develop coping mechanisms for dealing with the intensity, sensitivity, and the situations which otherwise may cause them problems later (Jacobsen, 1999).

Many of our brightest and most creative minds are not only going unrecognized, but they also are often given diagnoses that indicate pathology. For decades, psychologists and other health care professionals have given great emphasis to the functioning of persons in the lower range of the intellectual spectrum. It is time that we trained health care professionals to give similar attention to our most gifted, talented, and creative children and adults. At the very least, it is imperative that these professionals gain sufficient understanding so that they no longer conclude that certain inherent characteristics of giftedness represent pathology.

Clark, B. (1992). Growing up gifted: Developing the potential of children at home and at school, (4th ed.). New York: Macmillan.
Diagnostic and statistical manual of mental disorders, Fourth Edition. (1994). Washington, DC: American Psychiatric Association.
Jacobsen, M.E. (1999). Liberating everyday genius: A revolutionary guide for identifying and mastering your exceptional gifts. New York: Ballantine.
Seagoe, M. (1974). Some learning characteristics of gifted children. In R. Martinson, (Ed.), The identification of the gifted and talented. Ventura, CA: Office of the Ventura County Superintendent of Schools.
Silverman, L. K. (1993). Counseling the gifted and talented. Denver: Love Publishing.
Webb, J. T., & Latimer, D. (1993). ADHD and children who are gifted. Reston, VA: Council for Exceptional Children. ERIC Digests #E522, EDO-EC-93-5.
Webb, J. T. (1993). Nurturing Social-Emotional Development of Gifted Children. In K. A. Heller, F. J. Monks, & A. H. Passow (Eds.), International handbook of research and development of giftedness and talent (pp. 525-538). Oxford: Pergamon Press.
Webb, J. T. & Kleine, P. A. (1993). Assessing gifted and talented children. In J. L. Culbertson, & D. J. Willis (Eds.), Testing young children (pp. 383-407). Austin, TX: Pro-ed.
Webb, J. T., Meckstroth, E. A., & Tolan, S. S. (1982). Guiding the gifted child: A practical source for parents and teachers. Scottsdale, AZ: Gifted Psychology Press (formerly Ohio Psychology Press).
Winner, E. (2000). The origins and ends of giftedness. American Psychologist (55, No. 1), 159-169.

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Posted by: faithful | November 8, 2014

adhd revisited

How ADHD is radically mistreated

Research shows that children with ADHD are often extremely creative. Our institutions are failing them

How ADHD is radically mistreated
This article originally appeared on AlterNet.

In his 2004 book “Creativity is Forever“, Gary Davis reviewed the creativity literature from 1961 to 2003 and identified 22 reoccurring personality traits of creative people. This included 16 “positive” traits (e.g., independent, risk-taking, high energy, curiosity, humor, artistic, emotional) and 6 “negative” traits (e.g., impulsive, hyperactive, argumentative). In her own review of the creativity literature, Bonnie Cramond found that many of these same traits overlap to a substantial degree with behavioral descriptions of Attention Deficit Hyperactive Disorder (ADHD)– including higher levels of spontaneous idea generation, mind wandering, daydreaming, sensation seeking, energy, and impulsivity.

Research since then has supported the notion that people with ADHD characteristics are more likely to reach higher levels of creative thought and achievement than people without these characteristics (see herehereherehereherehereherehere,here, and here). Recent research by Darya Zabelina and colleagues have found that real-life creative achievement is associated with the ability to broaden attention and have a “leaky” mental filter– something in which people with ADHD excel.

Recent work in cognitive neuroscience also suggests a connection between ADHD and creativity (see here and here). Both creative thinkers and people with ADHD show difficulty suppressing brain activity coming from the “Imagination Network“:


Of course, whether this is a positive thing or a negative thing depends on the context. The ability to control your attention is most certainly a valuable asset; difficulty inhibiting your inner mind can get in the way of paying attention to a boring classroom lecture or concentrating on a challenging problem. But the ability to keep your inner stream of fantasies, imagination, and daydreams on call can be immensely conducive to creativity. By automatically treating ADHD characteristics as a disability– as we so often do in an educational context– we are unnecessarily letting too many competent and creative kids fall through the cracks.

Nine percent of children aged 5-17 years old are labeled ADHD on average per year, and placed in special education programs. However, new data from The National Center for Learning Disabilities shows that only 1% of students who receive IDEA (Individuals With Disabilities Act) services are in gifted and talented programs, and only 2% are enrolled in an AP course. The report concludes that “students with learning and attention issues are shut out of gifted and AP programs, held back in grade level and suspended from school at higher rates than other students.”

Why does this matter? Consider a new study conducted by C. Matthew Fugate and colleagues. They selected a population of students with ADHD characteristics who were part of a summer residential camp for gifted, creative, and talented students. The large majority of the students were selected for the program because they either scored in the 90th percentile or above on a standardized test, or had a GPA of 3.5 or greater in specific areas (e.g., mathematics, chemistry).

The researchers then compared this ADHD group of students with a non-ADHD group of students who were participating in the same gifted program. They gave all the students tests offluid reasoning, working memory, and creative cognition. Fluid reasoning involves the ability to infer relations and spot novel and complex patterns that draw on minimal prior knowledge and expertise. Working memory involves the ability to control attention and hold multiple streams of information in mind at once. They measured creative cognition by having the students come up with novel drawings that included one of the following elements: an oval shape, incomplete figures, and two straight lines.

The researchers found that students with ADHD characteristics (especially those who scored high in “inattention”) had lower working memory scores than the non-ADHD students, even though they did not differ in their fluid reasoning ability. This is consistent with past research showing that people with ADHD tend to score lower on tests of working memory (see here and here), but these findings also suggest that people with ADHD can still be quite smart despite their reduced ability to hold multiple pieces of information in memory. Also, despite their reduced working memory, 53% of the academically advanced students with ADHD characteristics scored at or above the 70th percentile on the creativity index. In fact, for both the ADHD and the non-ADHD group of students, the poorer the working memory, the higher the creativity!

This obviously has some important educational implications. To be sure, ADHD can make it difficult for students to pay attention in class and organize their lives. The importance of learning key attentional control skills should not be undervalued. But let’s not throw out the baby with the bathwater. As the researchers note, “in the school setting, the challenge becomes how to create an environment in which creativity is emphasized as a pathway to learning as well as an outcome of learning.”

One issue involves the identification of “twice exceptional” students and their appropriate educational programming. Assessments of creativity are notably absent from most gifted and talented programs in this country. Instead of automatically putting children with ADHD characteristics in special education, a broader assessment should be conducted. For one, IQ tests could be administered that focusless on working memory and memorization, and allows for a fairer assessment of fluid reasoning and non-sequential thought among this population of students.

A broader assessment could also allow students with ADHD characteristics to display their creative strengths, including divergent thinking, imagination, and hyperfocus (when interested). People with ADHD often are able to focus better than others when they are deeply engaged in an activity that is personally meaningful to them. Recent research suggests that the brain network that people with ADHD have difficulty suppressing (the “Imagination Network”) is the same brain network that is conducive to flow and engagement among musicians, including jazz musicians and rappers!


In terms of programming, problem-based learning (PBL) approaches may enable ADHD students to engage more with the material, and become active learners, rather than passive observers (see here). Additionally, learning can be assessed throughproject-based learning (PBL), in which students demonstrate their knowledge of the course material through the creation of different products (e.g., cartoons, role-playing, blogs, videos, newspaper articles), and the constant revision of these products.

Of course, these same possibilities should extend to all students in the classroom, academically advanced or not. Because we never really know whether an ADHD characteristic is a learning impediment or a creative gift.

Consider the case of John, who in 1949 attended Eton College and dreamed of becoming a scientist. However, last in his class, he received the following comment on his report card:

“His work has been far from satisfactory… he will not listen, but will insist on doing his work in his own way… I believe he has ideas about becoming a Scientist; on his present showing this is quite ridiculous, if he can’t learn simple Biological facts he would have no chance of doing the work of a Specialist, and it would be a sheer waste of time on his part, and of those who have to teach him.”

This was Sir John B. Gurdon, winner of the 2012 Nobel Prize in Physiology or Medicine for his revolutionary research on stem cells. Like so many other highly creative, competent individuals, he might have been referred for testing and given the label “attention deficit hyperactive disorder.”

It’s time to stop letting this happen.


Scott Barry Kaufman is adjunct assistant professor of psychology at New York University. He is cofounder of The Creativity Post and writes the blog Beautiful Minds for Scientific American Mind

Posted by: faithful | November 7, 2014

bpd videos: professional and self-help sources


Posted by: faithful | November 1, 2014

nea-bpd conference videos from 2005 through 2013

Past Yale NEA-BPD Conferences


Borderline Personality Disorder and Managing Related Cognitive Challenges

  1. Reading and writing deficits are common barriers–Staff communication sheets an diary cards.  –Read forms to the cient.  –Written therapy agreement.  –Move slowly don’t rush informed consent process
  2. All DBT strategies and structure standard:  Stages, hierarchy of targets, validation, contingencies, commitment, etc. –Increased use of orientation
  3. Memory deficits/Difficulty in sequencing  –Behavior analysis: slower process, use of visuals  –Longer time frames–Accessible skills curriculum (Skills system)
  4. Challenges related to generalizing skills (transitions and novelty can elicit dysregulation/avoiding)  –Quick Step Assessment simplification, task analysis, and shaping is necessary with DBT strategies  –Behavioral treatment planning (avoid micro-managing)  –Staff as skills coaches (challenging)
  5. Developmental issues/tensions:            — Polarized behavior with staff team (drive for autonomy)
    –DBT creates an egalitarian playing-field that fosters identity development/self-determination
    –Behavioral treatment planning (reciprocal communication/collaboration vs compliance/controlling
  6. Integration of therapy/environment
    –Training (IDD/MH issues: DBT, skills and skills coaching
    –Consultation to the client, due to developmental issues.

Issues: Cognitive Load Theory–Factors Increasing Cognitive Load (Cognitive Load Theory–Sweller)

Simultaneous Processing of Information
New Information
High Volume of Information
Interactivity of Information
Retrieval of divergent information
Rapid shifts without transition from one topic to another
Strong emotional responses to information
Strong emotional responses to the intervention

Evidence of Dysregulation:

Lack of Focus

Task Analysis
Orienting to all transitions and new topics
Worked examples
Validating the person’s experience
Positive reinforcement
Contingency management (letting people know how they are doing)

Series of skills (over-learned) to help span the duration/intensity
Ability to be present & effective in the moment (improving self-awareness)
Improved efficacy to manage novel events
Designed to facilitate recall and generalization
in complex contexts (implicit)
Structured and flexible (manage humanity)
Builds adaptive schema
Framework increases access to contextual learning
Aids effective transitions through events/system to construct adaptive chains
Map of strategic means to reach goals vs reacting impulsively, reduced avoidance, helps transitions
Mobilizes inner wisdom i context
Common language expands relational learning/capacities
Tools to actively/effectively manage environment/vehicle for self-determination

  • VIDEO: Panel Discussion; Gabriela Balf, MD, MPH, Julie F. Brown, LICSW, Bessel van der Kolk, MD, Anthony C. Ruocco, PhD, and Annita Sawyer, PhD


Impulsivity, Aggression, and Legal Involvement (Includes links to YouTube videos)


Common and Distinguishing Aspects of Dialectical Behavior Therapy and Mentalization Based Therapy (Video presentations)


Borderline Personality Disorder, Obesity, and Eating Disorders (Includes audio/video presentations)


Borderline Personality Disorder and Problems of Substance Use (Includes audio presentations)


Borderline Personality Disorder, Trauma, and Resiliency (Includes video presentations)


High Risk Adolescents and Their Families, Understanding and Treating Borderline Personality Disorder


Borderline Personality Disorder: Current Research and Treatments Consumer and Family Support Options


Borderline Personality Disorder: Origins, Treatments, and Concerns

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