Where Does a Pediatric Doctor Fit in the Care of Gifted Children?
Author: Marianne Kuzujanakis, M.D., M.P.H.
Citation: First published in the SENGVine, October 2011
I wear two hats: One—as a pediatrician. The other—as a parent of a gifted child. To be honest, there are days when neither hat fits comfortably, if at all. There are days when my medical knowledge just isn’t enough to understand my child, and other days when being a parent hasn’t always provided all the answers.
Can there be a synergy of these two roles?
Gifted kids do not suddenly become gifted on the first day of Kindergarten, nor are they gifted only during school hours. Most, if not all, parents may admit they felt hunches about their child’s abilities well before school age. Some parents may have even had concerns or questions about their child’s giftedness during these early years, yet they didn’t always know to whom to turn. Raising a gifted child can at times be a lonely and demanding journey for parents, and growing up as a gifted child is frequently fraught with challenges. Reaching out for an understanding voice may be difficult. Thus, many parents seek out organizations like SENG, as well as close friends and family members who can offer advice and support.
A sometimes overlooked individual who is ideally positioned to offer parents advice and support is the child’s medical doctor. These doctors may be pediatricians, family practitioners, naturopaths, or other allied health professionals. Many happy parents already find great comfort and advice from their children’s doctors, though others, for a variety of reasons, do not. Some parents may never have broached the subject of giftedness with their child’s doctor, considering giftedness not a medical issue, or feeling that discussing giftedness is marked with elitism. Doctors may feel likewise, and avoid the topic altogether. Some parents may also recall uncomfortable conversations with their child’s doctor or a previous doctor when giftedness was bought up, then quickly dismissed, and that made them hesitate to ever again discuss the subject. Some doctors, upon hearing about a child’s giftedness, may simply respond with “That’s wonderful. You must be lucky to have such an easy child to raise.” Argh.
By the time a child is five years of age, a child has typically seen his or her pediatric doctor a dozen times for healthy visits. With an average physical exam lasting twenty minutes, this amounts to four hours of face-to-face contact in those first five years, then one visit per year thereafter. Each visit is an opportunity – or missed opportunity – to address social, emotional, and developmental issues.
But is it important that pediatric doctors understand and address giftedness?
Medical doctors diagnose and treat a wide variety of acute and chronic medical conditions. Most are highly trained to do their job. Lectures and study about giftedness are not routinely part of the curriculum in medical training programs, yet giftedness can often play a significant role in the health and emotional well being of a gifted child. Reports indicate that doctors usually perform developmental assessments only 50% of the time, and these assessments primarily look at children not meeting the minimum standard developmental milestones. Many parents may be equally unaware that there is no specific pediatric medical record code (ICD or DSM) for “gifted.” Most doctors are compensated by the codes they indicate in the medical record. Having no specific medical code, many doctors, already overworked and pressed for time, have little incentive to discuss giftedness further.
When a child’s gifted needs are not served, the result can be expressed in a physical or emotional symptom. Many gifted children may experience bodily complaints as a result of a mismatch in their educational situation, or due to an unfulfilled emotional or social need. Stomachaches and headaches are common school avoidance symptoms. Eating disorders can be a result of poor self-esteem. Depression and suicidal attempts may result from feeling different or isolated or even bullied. Sensory intensities and the asynchrony of gifted children may be exhibited in extreme ways, sometimes making diagnoses difficult for those without knowledge of giftedness, and resulting in incorrect labeling of the gifted child. In other cases, a medical condition or learning disorder may almost completely hide one’s giftedness, as is seen in many twice-exceptional gifted children.
When worrisome health issues present at a pediatric doctor office, and if the doctor has a strong background knowledge of giftedness, he or she will be better positioned to understand and differentiate the symptoms from signs of giftedness, thus resulting in fewer misdiagnoses and fewer inappropriate medical treatments. If a doctor remains unsure of a presenting diagnosis, strong background knowledge of giftedness will still make it far easier to appropriately make any needed referrals, thus finding quicker answers for the parents and child.
Pediatric doctors are drawn into their careers by the thrill of working with children. They are among the most beloved of medical practitioners, and they do not take the privilege of caring for the youngest among us for granted. Many doctors are also gifted, and may understand the developmental paths of their gifted patients. They can be lifesavers for many parents who are anxious and exhausted by the enormous responsibility of raising these intense and complex children.
At the same time, many parents do not feel a need to discuss giftedness with their child’s doctor. Some parents feel able to be their own strong supportive advocates for their gifted children, and may also be gifted. Their children may have many friends who are gifted, and the stages of growing up are less bumpy, and more balanced. The personal need to discuss giftedness with one’s pediatric doctor in these situations may diminish.
But can parents do something to help make their good interactions better, or to improve their unsatisfying interactions, or even to help other more needy gifted families?
If parents of gifted children want or require more from their child’s doctor, they do not need to let the status quo remain. They may open an active dialogue about giftedness if they are aware that a doctor’s time is limited. Parents can slowly begin a conversation by staying focused on exactly what is needed at each particular visit, and to concisely articulate any specific questions.
Other suggestions for both parents who are already satisfied with the support they receive, and also for parents seeking greater support, include:
- Do your homework ahead of time when asking about topics such as testing, evaluation for a learning disability, consulting for depression, or other specific situation or information need.
- Consider asking your child’s doctor if he or she would be willing to allow an informational sheet or brochure to be posted in the office waiting room for other parents. SENG has several brochures, including one made in collaboration with NAGC called “Is My Child Gifted?”
- If needed, gently offer to educate your doctor about giftedness by putting together a brief typed listing of gifted resources such as SENG, NAGC, Davidson Institute, Hoagies Gifted, online parent forums such as GT-Families, TAGFAM (and its associated subgroups), and your state gifted association. If your doctor approves, you may offer to post the list on the waiting room bulletin board.
- If you have a supportive doctor, consider asking your doctor if he or she would be willing to run a local community support group for parents of gifted children. Possibly even suggest having the doctor train with SENG through the SMPG program.
- If you are or become quite comfortable with giftedness, you, too, may consider training as a parent facilitator through SENG and the SMPG program, and then offering your services for other parents of gifted children within your local area.
- Again…start slowly. Very slowly. Consider not just the needs of your child, but also the needs of other families like yours in your community. Some parents may not even be aware of organizations like SENG, and may be highly appreciative of any and all information and support. Start a grassroots gifted revolution!
“Be the change you want to see in the world.”- Mahatma Gandhi
Cultivating a satisfying relationship with your pediatric doctor in ways that fulfill the unique needs of you and your gifted child can be a warm ray of light upon everyone involved. No other professional has the potential to participate in the developmental course of a child for a longer time period. While many pediatric doctors already serve a vital role in the support of the gifted child, there is much more that can be done so all gifted families have similar support. If a professional such as a doctor truly appreciates, understands, and is available to offer advice when the road to adulthood becomes challenging, it can be life changing for a gifted child. By taking an active role in the cultivation of this relationship, every parent has the potential to play an important role in improving the lives of not just their own children, but all gifted families. Start a grassroots gifted revolution!
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Goerss, J., Clouse, R., & Webb, J. T. (2008). Health Care Providers Know Little about Gifted Children. National Psychologist. 16(2),12.
Hayden, T. (1985). Reaching out to the gifted child: Roles for health-care professions. New York: American Association for Gifted Children.
Liu, .Y.H, & Lien, J. (2005). Discovering Gifted Children in Pediatric Practice. Journal of Developmental and Behavioral Pediatrics. 26, 366-369.
Robinson, N. M., & Olszewski-Kubilius, P. M. (1996) Gifted and talented children: Issues for pediatricians. Pediatrics in Review, 17(12), 427-434.
Webb, J.T., Amend, E.R., Webb, N.E., Goerss, J. Beljan, & Olenchak, F.R., (2005). Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, Bipolar, OCD, Asperger’s, Depression, and Other Disorders. Scottsdale, AZ: Great Potential Press.
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SENG Director Marianne Kuzujanakis is a board-certified pediatrician with long-standing interests in parent and clinician education. Her residency training was at the Mid-South’s busy pediatric center in Memphis, TN, including Le Bonheur Children’s Hospital, St. Jude Children’s Research Hospital, and the University of Tennessee Medical Center. Subsequently, Dr. Kuzujanakis served for a time as a hospitalist, and then as the director of the outpatient department of a children’s teaching hospital. The majority of her medical career since then has been in primary care practice in Massachusetts, regularly dedicating a portion of her time as a clinical instructor, both through Harvard Medical School and also as the course director of a local clinician-training program for practicing pediatricians. She is currently focused on being the homeschool educator for her gifted child.