The Coincidence of Attention Deficit
Disorder and Creativity
Bonnie Cramond, Ph.D., The
University of Georgia, March 1995
This document has been reproduced with the
permission of The National Research Center on the Gifted and Talented. The Center is
federally funded under the Jacob K. Javits Gifted and Talented Students Education Act,
United States Department of Education.
Robert daydreamed so much that he was put out of school.
Frank went into such trancelike dreams that one had to shout at him to bring him back.
Equally problematic were Sam's restlessness and verbal diatribes. Virginia, too,
demonstrated a tendency to talk on and on. Thomas experienced school problems, in part
because of his high energy. Nick's tendency to act without thinking caused him to have
several scrapes with death and near-tragedies, such as plunging to the earth from the roof
of a barn, clutching an umbrella. In these examples we can see how the concentration, high
energy, and unique ways of thinking and behaving that were exemplified by Robert Frost,
Frank Lloyd Wright, Samuel Taylor Coleridge, Virginia Woolf, Thomas Edison, and Nikola
Tesla resulted in school problems, dark diagnoses, or worse. These are examples of
creative individuals whose behavior could also be interpreted as the inattention,
impulsivity, and hyperactivity of Attention Deficit Hyperactivity Disorder.
The stories of creative individuals are replete with
instances of childhood problems in school (Piirto, 1992; Thompson, 1971; West, 1991).
Although it has been argued that many creative individuals have suffered from mood
disorders and other clinically significant psychological problems (Hershman & Lieb,
1988; Jamison, 1993), there are others whose behavior, although irregular, may be more
indicative of their creativity than of any disorders. In the case of Janet Frame, New
Zealand's poet and novelist, her "difference" resulted in a diagnosis of
schizophrenia, confinement to a mental institution, and the scheduling of a lobotomy that
was only canceled when her first novel gained widespread distinction (Frame, 1984, pp.
110-111). In some cases the very qualities that cause creative individuals to have
problems are the same ones that may facilitate in their creative accomplishments. Edison's
energy, the vivid imagery in the daydreams of Frost and Wright, and Einstein's alternative
mode of thinking created problems for them in school, but were undoubtedly invaluable in
their creative endeavors.
Schools and families can best prevent misinterpretation of
a child's behaviors by becoming aware of those indicative of high creativity and
attempting to sort out the disabling from enabling ones. This is no small task because
many creative behaviors look like those that can result in a negative diagnosis. This is
particularly problematic for children because the creative potential may not yet be
manifest and only the aberrant behaviors are apparent. As in the case of Janet Frame, only
after one has been recognized as creative will some of the characteristics be viewed as
eccentric rather than problematic.
The issue of the relationship of creativity to
psychopathology is a mare's-nest of cases and attributions. It is not the purpose of this
work to attempt to resolve these issues. Rather, it is to look at the particular problems
that can beset creative children in today's schools when their behaviors are mistaken for
one of the most frequently diagnosed psychoeducational conditions, Attention Deficit
Hyperactivity Disorder (ADHD).
This is not only possible, but likely, because ADHD has
been listed as the most common reason for referral and diagnosis in children seen in
psychological clinics (Frick & Lahey, 1991). Yet, few schools, psychologists, or
pediatricians test or diagnose creativity in children who are having problems in school,
in spite of the fact that Wallach and Kogan (1965) found that highly creative children
engage in "disruptive, attention-seeking behavior" in the classroom (p.
294-295). Similarly, Getzels and Jackson (1962) found that they are not valued by their
teachers as much as more conforming, less creative students.
Of course, not all creative individuals exhibit
impulsivity, motor hyperactivity, and inattention. By the same token, not all children who
manifest ADHD behaviors will be highly creative. The specific concern here is for creative
children whose behaviors may be seen as maladaptive in school and who are incorrectly
diagnosed as suffering from ADHD, the reverse situation could also occur, i.e., children
with ADHD incorrectly labeled as creative, it is unlikely because creativity is
infrequently identified. On the other hand, ADHD has been listed as the most common reason
for referral and diagnosis in children seen in psychological clinics (Frick & Lahey,
1991). Furthermore, the consequences of incorrectly labeling a child as creative are not
as severe as those for incorrectly labeling someone as ADHD.
Brief History of ADHD
******[Section to be added]
There is a possibility that structural differences in the
brain are related to the differences in cognitive functioning that appear as ADHD or
creativity. Neurobiological anomalies are reported in both the literature on ADHD (Hynd,
Hern, Voeller, & Marchall, 1991) and the literature on creativity (Herrmann, 1981;
Torrance, 1984). Geschwind (1984), though emphasizing that creativity could not be
attributed solely to the right hemisphere, expounded upon the remarkable talents
associated with individuals who exhibit anomalous or mixed brain dominance. Geschwind and
Galaburda (1987) also noted the predominance of the right hemisphere in spatial
orientation, emotional expression, and attention (p.44-45). The importance of effective
communication between the hemispheres for creative productivity was noted by Restak (1993)
who also described instances of brain damage that enhance creativity.
The possibility of structural differences in the brain
being a link between ADHD and creativity was strengthened by some empirical evidence
provided by Shaw (1992). She found that a group of bright, ADHD children exhibited greater
crossed eye-hand dominance and left laterality than a group of normal children matched by
age, sex, and IQ. The ADHD group also had higher figural creativity and more use of
imagery in problem solving.
Bachtold (1980) suggested that observed brain differences
cause diverse ideation. She has claimed that intelligent individuals who are bombarded by
ideas seek to make sense of them by organizing them into new perceptual relationships.
Thus the creative, original idea is born.
The cognitive processing that results in ideation and
demands on attention was noted in studies with ADHD students. In two studies, Shaw (Shaw,
1992; Shaw & Giambra, 1993) found that ADHD students reported a greater abundance of
spontaneous thoughts during a problem-solving exercise. In one experiment the peripheral
information was used to solve the problems (Shaw, 1992), and in the other it was seen as
unrelated to the vigilance task (Shaw & Giambra, 1993). Shaw and Giambra interpreted
this as an indication that ADHD students have more internal distractions from fleeting
sensory input and less command over their thought processes than do others, especially
during boring tasks. On the other hand, Shaw (1992) speculated that such spontaneous and
diverse ideation may be part of the process that fosters more creative responses on a test
of divergent thinking.
Temperament and Mood
Sensation Seeking: Another possibility is that there
are certain temperament traits that predispose individuals to exhibit behaviors that are
characteristic of both ADHD and creativity. For example, the in-born temperament trait of
sensation seeking has been linked to both ADHD (Zuckerman, 1983) and creativity (Barron,
1988; Farley, 1981; Torrance, 1968). Shaw and Giambra (1993) also noted the link provided
by the trait of sensation seeking in both creative and ADHD populations.
Zuckerman (1983) reported that sensation seeking is greater
in ADHD children than in normal children. This may be understood in light of the
hypothesis that ADHD children seek stimulation as a result of underarousal in the
reticular activating system and cortex (Klove, 1989). According to Zentall and Zentall
(1983), there is an optimal level of stimulation necessary to maintain the engagement of
attention disordered children. This may explain the situational variability that has been
observed in the manifestation of ADHD characteristics (Frick & Lahey, 1991). Douglas
(1983) proposed that ADHD children are usually either underaroused by dull, repetitive
tasks or hyperaroused by interesting ones.
Farley (1981) has proposed that the same is true of
creative individuals. In fact, Farley has proposed a biologically based model of
creativity that explains stimulation seeking as related to low innate arousability
(Farley, 1981; 1985). From his body of research examining the relatedness of creativity to
arousability, Farley has concluded that:
The search for variety and intensity of stimulation of the
low arousal individual will lead to the openness to experience, the flexibility, risk
taking, high energy level, preference for complexity, playfulness, receptivity to new and
novel ideas and experiences, and so on that are held to be characteristic of the creative
person, as well as the flexibility of performance, generation of performance variety,
novelty, complexity, and so on that are often held to be important attributes of creative
performance. Thus, the personality attributes of the creative individual, as well as the
characteristics of creative performance, are seen as in part deriving from or serving the
sensation-seeking motive. (pp.24-25)
Most pertinent, Farley (1981) concluded that the
implications of stimulation seeking are of great importance for the childhood disorder of
hyperactivity, which he described as a disorder characterized by stimulation seeking.
Therefore, he advised that children so diagnosed should be treated with adaptive education
rather than adaptive medication. Specifically, he proposed that such children "...be
exposed to arousing education, perhaps open-space classrooms, more unstructured
conditions, discussion and discovery instructional modes, divergent creativity
experiences, arousing, extroverted teachers, and so on" (p.22). In short, nurture
Sensitivity to Stimulation: Another temperament
connection may be provided by Dabrowski's Theory of Positive Disintegration (1964).
According to Dabrowski, individuals may manifest extreme sensitivity to stimulation, or
psychic overexcitabilities, in any of five areas: intellectual, psychomotor,
imaginational, emotional, or sensual. Individuals who have an innate tendency to
experience and express themselves in certain combinations of these areas have the
potential for a higher level of development. Of the five, emotional, intellectual, and
imaginational overexcitabilities have been theorized to be most indicative of
developmental potential (Piechowski & Colangelo, 1984). Viewed as promising by
Dabrowski, emotional overexcitability in childhood may be viewed as the emotional
liability of ADHD; psychomotor overexcitability may be viewed as hyperactivity. The
overexcitabilities in combination may produce an intensity that has often been used to
describe creative individuals (Getzels & Csikszentmihalyi, 1976). Using similar
language, Bachtold (1980) described the creative individual as a person with a low sensory
threshold and strong reactions to sensory stimuli.
Depression: Finally, there is the observation that
ADHD-like behavior can result from depression (Silver, 1992; Weinberg & Emslie, 1990).
Weinberg and Emslie (1987, 1990) noted that many children who are diagnosed with ADHD also
suffer from depression or bipolar disorder (depression alternating with manic states).
They also observed that both depression and mania appear to have biological bases in brain
anomalies. In the case of depression, the right cerebral hemisphere is implicated as
malfunctioning (Weinberg & Emslie, 1990, p.8).
Likewise, depression and bipolar disorder have been noted
in the lives of creative people (Hershman & Lieb, 1988; Jamison, 1993; Leonard, 1989;
Pickering, 1974; Richards, 1981, 1990; Richards & Kinney, 1990), especially among
writers (Andraeson & Glick, 1988; Piirto, 1992; Restak, 1993). The mechanism for the
relationship between creativity and depression is unclear. Because depression and bipolar
disorder run in families, there is an indication of a heritable factor (Jamison, 1993),
either in some structural or biochemical differences in the brain. On the other hand, the
sensitivity and intensity that facilitates creative expression may also make highly
creative people more susceptible to depression (Piirto, 1992). The belief in the latter is
what causes many creative people to refuse drug treatments to lessen the ravages of mood
disorders; they believe that the drugs lessen their creativity (Restak, 1993, p.73). The
consensus among researchers working on the relationship between creativity and mood
disorders seems to be that some depression and mania may enable creative production, but
if the disorder becomes too severe it is disabling (Andraeson & Glick, 1988; Jamison,
1993; Richards, 1981, 1990; Richards & Kinney, 1990).
Characteristics of Creativity and ADHD
Although the primary symptoms of ADHD are inattention,
hyperactivity, and impulsivity (Frick & Lahey, 1991). A review of the literature on
ADHD and creativity, respectively, revealed several identical or similar characteristics.
The characteristics were grouped for the following discussion according to conceptual
similarity, although in some cases the working indicates a more positive or negative
connotation of a behavior.
As is apparent in the changed conceptualization,
inattention is one of the areas that has received the most interest in recent years and is
considered a defining characteristic of ADHD. Lahey and colleagues (1988) described the
ADHD child as one who is easily distracted, often fails to finish things, and frequently
shifts activities. Yet, creative people are described as having a broad range of interests
and showing a tendency to play with ideas, sometimes losing interest in one to take up
another. A famous example of this is Leonardo da Vinci. Although known for his painting,
there are only 17 paintings that can be attributed to his 67 years as an artist, and some
of these are incomplete. His tendency to leave projects unfinished reportedly resulted in
Pope Leo X/s exasperated exclamation, "This man will never accomplish anything! He
thinks of the end before the beginning" (Wallace, 1966, p.150). Even Freud was
fascinated with Leonardo's tendency to abandon projects claiming it was because the artist
had been abandoned by his father (Freud, 1910). However, most pertinent for this
discussion may be Leonardo's explanation for his failure to finish his projects: his
interests were so many and so diverse (Wallace, 1966, p.169).
According to Cheney (1981), Tesla also pursued so many
ideas that he "...often did not follow-up on his intuitions, theories, and
preliminary experiments to the point of verification" (p.147). This became a problem
because others were then free to complete the invention and get credit for it as Tesla
claimed Marconi did with the telegraph. Tesla was driven to action at one point when his
bookkeeper reminded him that money was running out and his inventions were not being
completed (p. 127).
According to Werry, Reeves, and Elkind (1987), the lack of
attention or concentration indicative of ADHD is also exemplified by daydreaming and not
seeming to listen. However, this observation could also be made of a person who is paying
very close attention to internal thoughts and visualizations. It is possible that the
creative person is preoccupied, as such individuals are wont to be according to Barron
(1976). Nikola Tesla has such strong visualization abilities that he would imagine the
workings of his inventions to great details without putting anything on paper or
conducting any experiments until all of the problems were worked out (Cheney, 1981). Frank
Lloyd Wright reported that his reveries were so intense that his uncle would have to shout
at him to get him back (Piirto, 1992, p.310). Torrance noted that, "Robert Frost was
dropped from school for what we call daydreaming; during some of his lapses from attention
he was probably revolving a poem in his mind. Other eminent creative writers, scientists,
and inventors have had similar experiences" (Torrance, 1963, p.49).
A key question here is how to differentiate hyperactivity
from a high level of normal activity (Rutter, 1989), or to discriminate between
restlessness that prevents one from completing tasks and restlessness that drives one to
be productive. According to the DSM-IV (McBurnett, Lahey, & Pfiffner, 1993),
hyperactivity is observed as excessive fidgeting, difficulty staying seated, excessive
running and climbing, and difficulty playing quietly, although in adolescents and adults
it may be manifested as internal feelings of restlessness. For example, the workers in the
laboratory with Edison and Tesla were amazed at the high energy of these two men; they
were said to work without sleep for two to three days when necessary (Cheney, 1981, p.31).
Such high energy served them well in their adult years; however, there are indications
that it got Tesla into hot water, or rather milk, in childhood. According to Cheney (1981)
Tesla was quite an active child,
"...he was almost drowned on numerous occasions, was
nearly boiled alive in a vat of hot milk, just missed being cremated, and was once
entombed (overnight in an old shrine). Hair raising flights from mad dogs, enraged flocks
of crows, and sharp tusked hogs spiced this catalogue of near-catastrophes." (p.8)
Whatever it is called, lists of characteristics of creative
individuals often describe them as radiating vitality (Ochse, 1990) and having a high
energy level (Davis, 1986). Adding another term to the group, Dabrowski described
psychomotor overexcitability as one of the five areas of heightened sensitivity, along
with intellectual, imaginational, emotional, or sensual, that individuals with the
potential for higher development may possess (Piechowski & Colangelo, 1984). Defined
as a surplus of energy (Piechowski, 1986), psychomotor overexcitability is manifested as
physical activity and expression of emotional tension, e.g., rapid speech, restlessness,
fast games and sports, marked enthusiasm, delinquent behavior, impulsive actions, and
nervous habits (Piechowski, 1979).
In testing whether the overexcitabilities could distinguish
between gifted and nonidentified students, Ackerman (1993) found that Psychomotor, along
with Emotional, and Intellectual Overexcitabilities as measured by the Overexcitabilities
Questionnaire (OEQ, Piechowski & Cunningham, 1985), differentiated between the two
groups. When comparing a more and less creative group, Gallagher (1986) discovered that
students who scored in the top third on a figural test of creativity had significantly
higher Psychomotor Overexcitability scores than those who scored in the bottom third on
the creativity test. Calic's research (1994) compared a group selected for creativity and
academic ability to one selected for academic ability alone on their responses to the OEQ.
The more creative group (visual and performing artists) had higher Psychomotor,
Imaginational, and Sensual Overexcitability scores than did the comparison group. Of
course, not all creative individuals manifest such energy. Perhaps, as Piechowski and
Cunningham (1985) conjectured, the pattern and interaction of heightened sensitivities may
differentiate types of creative personalities as well as separate creative from
intellectually gifted individuals.
According to the DSM-IV, diagnostic criteria for
impulsivity include observations that the individual frequently calls out in class, and
has difficulty awaiting a turn (McBurnett, Lahey, & Pfiffner, 1993). The DSM-III-R
also included the criterion of acting without thinking, often by engaging in dangerous
activities without considering the outcome, although we were cautioned that this does not
apply to thrill seeking behavior (American Psychiatric Association, 1987). Some problems
may be noted immediately with the overlap of this criterion with the previous on of
hyperactivity. Using Piechowski's (1986) description of Psychomotor Overexcitability, both
high levels of activity and impulsivity would be included. Another problem is with the
caveat that the impulsive behavior should be exclusive of thrill seeking. How would an
observer differentiate? Perhaps that is why this descriptor has been dropped from the
One of the key descriptors of creative individuals is risk
taking, sensation seeking, or thrill seeking (Barron, 1988; Farley, 1981; Torrance, 1968).
Described earlier as an innate temperamental trait of sensation seeking, perhaps it was
this tendency that Ghiselin (1952) referred to as a need to transcend the established
order into disorder and chaos motivated by a restlessness, or "less psychic inertia
than average man" (pp.14-18).
Other Behavioral Similarities
Although the primary symptoms of ADHD are listed as
inattention, impulsivity, and motor hyperactivity (Frick & Lahey, 1991), other
characteristics include difficult temperament, deficient social skills, and academic
underachievement (Werry, Reeves, & Elkind, 1987). These symptoms do not sufficiently
differentiate the creative from the child with ADHD either.
Difficult Temperament and Deficient Social Skills:
The stories of creative individuals with what are considered difficult temperaments are so
abundant that the characteristic has become a stereotype. According to Dabrowski
(Piechowski & Colangelo, 1984), the emotional volatility that is a key to this
perception would be expected in a creative person because of the heightened sensitivity
and reactivity to emotions.
Individuals who exhibit unconventional behavior, as many
creative people do (Sternberg, 1988), may be seen as lacking in social skills. Getzels and
Csikszentmihalyi (1976) described the personalities of the artists that they studied as
aloof and nonconforming to conventional standards of behavior
Kerr (1985) proposed that some antisocial behavior that
creative people exhibit may be a defense against others' reactions to their differentness.
Shee described eminent women with personality types of thorn or shells. The thorns are
exemplified by Gertrude Stein, Georgia O'Keefe, and Margaret Mead whose behavior was often
caustic; Marie Curie retreated into the shell of shyness that Eleanor Roosevelt and Maya
Angelou fought to leave (p.71).
Deficient social skills may also be inferred from, or
related to, a preference for solitude. Maslow (1971) made a case for privacy and
detachment from others as essential to the creative process, and Piirto (1992) called
solitude "the core of the creative process" (pp. 48-50). Ochse (1990) explained
the need for solitude both as part of the creative personality and process.
Academic Underachievement: Even academic
underachievement is not a clear distinction between those who suffer from an impairing
condition that requires treatment and those whose interests and talents do not coincide
with school requirements. The stories of academic underachievement, or irregular school
achievement, of famous creative individuals such as Einstein and Edison are legend.
Goertzel, Goertzel, and Goertzel (1978), in their chronicle of 300 eminent people,
reported that the artists in the group were not typically considered to be good students
in school. Just as Rutter (1989) speculates about the difficulty of differentiating
between inattention and diverted attention, so too, is it difficult to differentiate
between underachievement and diverted achievement in children.
The Nature of the Creativity-ADHD
The exact nature of the relationship between creativity and
ADHD is not known at this time, in large part because creativity and ADHD are themselves
such complex and puzzling constructs. However, there are several possible relationships.
The first, perhaps most obvious, is that there is not
relationship. The purpose of this paper is to refute this belief by illustrating the many
similarities in the behaviors that are indicative of both creativity and ADHD. Another
possibility is that creativity and ADHD are two names for the same syndrome. This is also
unlikely because of the many recorded cases of creative people who do not exhibit any
characteristics of ADHD and vice-versa.
What we are left with is some overlap of creativity and
ADHD. Most people who are knowledgeable about both creativity and ADHD would probably
agree with this, but it is the nature of the overlap that spurs disagreement. There seems
to be sufficient evidence that there could be physiological, cognitive, and/or temperament
bases underlying both conditions. Certainly, there may be some people who are both highly
creative and suffer from ADHD; however, it would seem that by definition such people could
not be highly productive because a diagnosis of ADHD requires clinically significant
impairment (DSM-IV, American Psychiatric Association, 1994). For children, whose creative
potential rather than productivity is identified, this may be more likely. However, there
is also the concern that creativity may be mistaken for ADHD in some cases.
Although a thorough diagnosis will seek to exclude
developmental disorders, mood disorders, and the like (DSM-IV, American Psychiatric
Association, 1994), many diagnoses are not thorough. According to Dr. Mark Stein, who runs
a University of Chicago clinic for children and adults with ADHD, comprehensive
evaluations are rarely done ("Attention Disorder," 1994). Also, there is no
similar caveat for clinicians to look for creativity. As Webb (1993) noted, few
professionals evaluating a child for ADHD have had any training in recognizing the
characteristics of the gifted and creative children.
It is the intent here to look at similarities between
behaviors indicative of ADHD and creativity in order to question whether some children who
exhibit such behaviors are doing so because they are creative and do not have a
disorder. As Richters and Cicchetti (1993) argued, there is reason to question the
usefulness of a behavioral diagnosis as an assumption of an underlying mental disorder.
Such questions remind us to look at issues in light of new information and that
"there are no fixed, immutable answers to questions concerning the boundaries between
disorder and nondisorder" (p.6).
Perhaps what differentiates individuals who use their rapid
ideation to create versus those who are disruptive and unproductive is the talent and
opportunity to express their energies and ideas in some creative mode. Some indication of
this may be found in Barron's (1976) description of the findings of a series of studies of
creative individuals in various fields carried out by the Institute of Personality
Assessment and Research (IPAR) at the University of California at Berkeley in the 1960s.
Using personality inventories, the researchers found the creative groups to have more
evidence of psychopathology, but also greater ego strength than less creative comparison
groups in the same professions. The conclusion about the creative groups was that
"...they are much more troubled psychologically, but they also have far greater
resources with which to deal with their troubles" (p.197). Richards (1981) described
the advantages of rapid ideation, heightened emotional awareness, and energy to
creativity, but warned that there must be some balance of a strength to fully use these
abilities so that they do not degenerate into psychopathology. Calic (1994) found that the
creative adults in her study described how they used their energy, emotionality,
sensuality, and rapid ideation to create.
Because IPAR's, Richards', and Calic's findings were based
on studies of adults, it may be that understanding and control of ADHD-like behaviors is
developmental. If such is the case, then perhaps it would be most helpful to assist
children in finding creative outlets and tapping into their restlessness to produce
something creative. The role of the parent and teacher would be to help the child find a
mode of expression and learn to use that to get the ideas, emotions, and energy out
ADHD and Giftedness
Although it has been the primary purpose of this paper to
relate the similarity of behaviors indicative of ADHD and creativity, it is important to
note that many intellectually gifted children also exhibit behaviors that are associated
with a diagnosis of ADHD. Although it is possible for children to be both gifted and ADHD,
there are dangers of misdiagnosis for gifted children when the evaluation is not thorough
(Webb & Latimer, 1993).
Observed as inattentive, the gifted child may be bored.
Described as hyperactive, the gifted child may be displaying a high energy level. Regarded
as difficult and obstreperous, the gifted child may be questioning authority and creating
a personal, complex rule system (Webb & Latimer, 1993).
Michael Kearney, the youngest college graduate in the
world, was diagnosed as a toddler with ADHD and prescribed Ritalin. However, his parents
declined drug treatment and decided to nurture Michael's genius with education instead. He
started school at age three, entered junior college at six, and graduated from he
University of South Alabama at ten (Patureau, 1994). His father, Kevin Kearney, refused
the notion that Michael's inattention is due to a lack of attention: "In fact,
children like Michael have an attention surplus. He's so much faster than we are. In two
seconds he's figured out what you're going to say. He's toyed with a few answers and now
he's looking around waiting for you to finish. It looks like he's not paying attention and
it drives teachers crazy. (Kearney quoted in Patureau, 1994, p.M4).
According to Webb and Latimer (1993, the most important
distinctions between the gifted child and the child with ADHD are the situationality of
the behavior and the variability of task performance. They have contended that the
"activities of children with ADHD tend to be both continual and random; the gifted
child's activity usually is episodic and directed to specific goals" (p.2). Also,
they have observed that children with ADHD exhibit inconsistency of performance and effort
in almost all tasks and in all settings, except television or computer games, although the
extent of the behaviors and the degree to which they are perceived as troublesome may
vary; gifted children will usually do well in classes that are enjoyable and appropriately
challenging. However, some researchers have not seen situational variability as a reason
to rule out a diagnosis of ADHD (Barkely, 1990; Schaughency & Rothlind, 1991). To
clarify this, the newest DSM-IV guidelines for the diagnosis of ADHD recommend that the
symptoms be observed in two or more situations and that the "disturbance causes
clinically significant distress or impairment in social, academic, or occupational
functioning" (American Psychiatric Association, 1994, p.E:9).
Because Attention Deficit Hyperactivity Disorder (ADHD) is
a psychological classification that has undergone numbers changes in conceptualization and
diagnosis over time (Meents, 1989) and place (Levine & Melmed, 1982), and because
extant treatments for this disorder have shown limited and questionable long-term results
(Meents, 1989; Silver, 1992; Swanson et al., 1993), it is important for educators to look
carefully at the behaviors that may warrant such a diagnosis and label for a child. This
is of special concern to the field of gifted/creative education because the very behaviors
that may induce a diagnosis of ADHD have also been shown to have correlates in the
literature on creative behavior (Cramond, 1994b).
Parents and teachers are cautioned to look carefully at
behaviors exhibited by children for what may be potentialities instead of deficiencies.
Specific recommendations in this regard give guidance when a problem is suspected, when
the child is recommended for psychological screening, and after a diagnosis of ADHD is
Recommendations for Teachers and
When Attention Deficit Hyperactivity
Disorder is suspected
Recommendation 1: Be open-minded to the possibility that
difficult behaviors may be indicative of special abilities, such as creativity, as well as
problems. Research basis: There are many similarities in the behavioral manifestations
of creativity and ADHD that may cause errors in attribution (Cramond, 1994b). Farley
(1981) and Shaw (1992) have speculated it is the very qualities that are involved in the
ADHD diagnosis that enable creative responses.
Recommendation 2: Become knowledgeable about the
behavioral manifestations of creativity and ADHD throughout the life span. Research
Basis: Although more recent evidence indicates that ADHD is a lifelong condition (Teeter,
1991), the very behaviors that cause difficulties for children in school situations may be
helpful in adult careers for which high energy, risk-taking, flexibility in ideation, and
ambition may be assets (Hartmann, 1993; Levine & Melmed, 1982; Winslow & Solomon,
1987). Also, children with creative potential may not manifest consistent creative
productivity, especially in certain fields, until they mature (Bloom, 1985).
Recommendation 3: Observe and record under what
conditions the key behaviors are intensified or reduced. Research Basis: Because
ADHD-type behaviors may be exacerbated when the child is required to engage in
unstimulating, highly structured, repetitive tasks (Frick & Lahey, 1991), noting under
what conditions the child is most likely to exhibit the behaviors may be instructive.
According to Farley (1981), sensation seeking behavior is increased in unstimulating
Recommendation 4: Ask the child what s/he is thinking
about right after a period of daydreaming. Research Basis: Because it is difficult to
differentiate between inattention and diverted attention (Rutter, 1989), it may be
informative to discover whether the daydreaming child is not attending or is attending to
alternative stimuli, plans, or ideas that are focused.
If the child is referred for psychological screening
Recommendation 5: Whenever possible, choose a
psychologist who is knowledgeable about giftedness and creativity as well as Attention
Deficit Hyperactivity Disorder, or willing to learn. Research Basis: Because there is
no definitive test for ADHD, the diagnosis of this disorder is made through the use of
behavioral checklists. Such a diagnosis is susceptible to the interpretations of various
observers as to the frequency and severity of the behavior, and correlations of behaviors
between parent and teacher reports have been low (Biederman, Keenan, & Faraone, 1990;
Schaughency & Rothlind, 1991). Webb (1993) observed that few psychologists have had
any training in recognizing characteristics of gifted and creative children. Therefore, a
psychologist who is willing to learn about the similarity of characteristics, perhaps by
reading a paper such as this, would be preferred.
Recommendation 6: Be sure that a creativity test or
checklist is complete in addition to the ADHD checklist. Research Basis: Once the
behaviors have been interpreted as deficiencies, it is unlikely that related proficiencies
will be seen. In a recent study (Cramond, 1994a), it was determined that half of the ADHD
diagnosed group scored above the 70th percentile on a test of creativity, yet only seven
of the 34 (21%) children had been screen for the gifted program. Eleven of these children,
32% of the ADHD group, scored above the 90th percentile, and only six had been screened
for the gifted program. None had any indications of observed creativity in their records,
although several and indications of other problems such as learning disabilities and
If the child is diagnosed as having ADHD
Recommendation 7: Get a second opinion. Research
Basis: Even in a clinical setting with diagnoses based on interviews and judgement of
symptoms indicative of the DSM-III, reliability of diagnoses were very low (Werry,
Methven, Fitzpatrick, & Dixon, 1983). The definitions and criteria for diagnosis of
ADHD have changed so often that even those who research ADHD are in conflict over its
causes and defining behaviors (Meents, 1989). Children diagnosed under one version of the
DSM criteria would not be diagnosed under another (Schaughency & Rothlind, 1991).
Thus, whether a child is diagnosed with ADHD may depend to a large extent upon when
(Meents, 1989) and where (Levine & Melmed, 1982) the referral is made.
Recommendation 8: Be cautious about recommendations for the
use of methylphenidates or other drugs. Research Basis: There is reason to be concerned
that the increase in attention and left hemisphere enhancement come at a price to
cognitive functioning in other areas (Malone, Kershner, & Siegel, 1988), although some
studies have indicated that groups on medication perform as well or better on tests of
creativity while they are on medication (Funk, Chessare, Weaver, & Exley, 1993;
Solanto & Wender, 1989). Other complicating factors associated with the use of
methylphenidates, of which Ritalin is the most commonly prescribed for ADHD, include the
worsening or inducement of depression (Weinberg & Emslie, 1990) as well as appetite
reduction, insomnia, increased irritability, headaches, stomachaches, motor and/or vocal
tics, and suppression of height and weight gain (DuPaul, Barley, & McMurray, 1991).
However, for most children side-effects are mild and associated with higher dosages
(DuPaul et al., 1991). Of equal concern in assessing the costs and benefits of medication
treatment is the lack of evidence of any long term benefits of the medication (DuPaul et
al., 1991; Meents, 1989). In their review of the literature on the effect of stimulant
medication on children with ADHD, Swanson and is colleagues (1993) concluded that with
medication one should expect temporary management of diagnostic symptoms and improvement
of associated features, but should not expect predictability of response, absence of side
effects, or improvements in long-term adjustment in terms of academic achievement or
reduction of antisocial behavior (p.159).
Recommendation 9: Be cautious about recommendations for
an unstimulating curriculum with lessons broken into small parts. Research Basis:
Although such recommendations are common, the limited effectiveness of interventions on
the long-term achievement of children diagnosed with ADHD (Silver, 1992) cast doubt on
their broad, continued usage. Zentall and Lieb (1985) found that a structured
prescribed-response condition reduced the activity levels of both hyperactive children and
controls, suggesting that structure is useful in decreasing activity level. However,
Farley's (1981) research connecting both hyperactivity and creativity to sensation-seeking
lead his colleagues and him to a series of studies to investigate the aptitude-treatment
interaction of level of sensation seeking and crossed with educational environment,
traditional, and structured versus unstructured and open. He concluded that hyperkinetic
children need arousing, unstructured, creative teaching to perform best, exhibit fewer
hyperkinetic symptoms, and report greater satisfaction with school. It is clear that given
the heterogeneity of the group of children who are diagnosed under the umbrella
designation of ADHD, the needs of the individual child should be considered in designing a
modification in the curriculum (Silver, 1992). Gifted, creative children who exhibit
behaviors typical of ADHD still have the needs for complex, stimulating curriculum that
other gifted, creative children require.
Recommendation 10: Provide opportunities both inside and
outside of school to enhance creativity and build self-esteem. Research Basis: The
emphasis in research and intervention with ADHD is on identifying deficiencies (c.f. Frick
& Lahey, 1991; McBurnett, Lahey, & Pfiffner, 1993) and remediating them (c.f.
Burcham, Carlson, & Milich, 1993). Although good school-practices for ADHD children
should focus on strengths as well as weaknesses (Burcham it al., 1993), it is often up to
the parents to provide opportunities for expression of creative strengths outside of
school. A negative label may affect not only the way a child is perceived by teachers, but
also the child's self esteem (Rosenthal & Jacobson, 1968). If medication is
prescribed, there may be psychological effects on attribution for behavior (Swanson et
al., 1993), in that the child gives up responsibility for his behavior and charges his
good or bad behavior to the medication. Therefore, it is important to bolster the self
esteem and nurture strengths as much as possible within school and without. Parents and
teachers should work together to help the child find a mode of expression and learn to use
that to get the ideas, emotions, and energy out productively.
About the Author...
Dr. Bonnie Cramond is an Associate Professor of
Education Psychology at the University of Georgia and an affiliate for the Torrance Center
for Creative Studies. Her teaching and research interests are in the areas of giftedness
and creativity about which she has written several articles and chapters. As a teacher,
researcher, and parent she has addressed audiences of teachers, researchers, and parents
at the local, regional, and international levels interested in theoretical and practical
information about gifted and creative individuals.
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cited in the original publication, which is available through the University of
Connecticut (ordering instructions follow). I've reprinted a few select references which
may be of interest. If you would like to explore some of the other work referred to in
this document, you can either order the original publication, or email me with specific
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methylphenidate. Pediatrics, 91, 816-819.
Gallagher, S.A. (1986). A comparison of the concept of
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(Ed.), Creativity (pp. 164-175). New York: Touchstone.
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creativity. Creativity Research Journal, 3, 202-217.
Shaw, G.A. (1992). Hyperactivity and creativity: The tacit
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gifted people with learning difficulties, computer images, and the ironies of creativity.
Buffalo, NY: Prometheus Books.
The National Research Center on the Gifted and Talented
(NRC/GT) is a collaborative effort of the University of Connecticut, City University of
New York/City College, Stanford University, University of Virginia, Yale University, 52
state and territorial departments of education, over 339 public and private schools, over
167 content area consultants, and stakeholders representing professional organizations,
parent groups, and businesses. The funding for the Research Center has been provided by
the Office of Educational Research and Improvement, United States Department of Education,
under the Jacob K. Javits Gifted and Talented Students Education Act of 1994.
The Coincidence of Attention Deficit Hyperactivity Disorder and Creativity
by Dr. Bonnie Cramond
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