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Tips for Parents: Therapy with Profoundly Gifted Children and Adolescents with Dr. Edward Amend

Gifted Resources

The following article expands on highlights and insights from one of our Expert Series events, which are exclusive for Young Scholars and their parents. 

Authored by: Edward R. Amend, Psy.D.

Summary

Individual and/or family therapy can be useful for families with profoundly gifted (PG) youth. Therapy can focus on either personal growth or management of specific difficulties like anxiety, depression, or executive functioning challenges associated with Attention-Deficit/Hyperactivity Disorder (ADHD).  Understanding one’s giftedness and its implications is often an important goal because understanding, accepting, and addressing one’s giftedness is essential to positive growth. Remember, therapy is a process that takes time. Usually, the problems for which you sought therapy did not start yesterday, and they are not going away tomorrow.

There are several types of therapeutic interventions that can be helpful, but the most important variable consistently is the relationship between the therapist and the client. Building solid rapport so that individuals can trust and work together to solve problems is needed. Therapy should help an individual understand the connection between their thoughts, feelings, and behaviors. Cognitive-behavioral therapy (CBT) and its offshoots like dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT) can help PG youth to understand themselves and their asynchrony. For example, DBT is an intensive, skill-based therapy that focuses on coping skills and managing emotional dysregulation.

Finding a therapist for your profoundly gifted child involves learning about a therapist’s understanding of giftedness. When seeking therapy, parents should use available resources to ask questions of perspective therapists, to gauge the therapist’s understanding of giftedness and ensure a better fit. If a therapist does not understand giftedness, and especially profound giftedness, understanding the role giftedness plays in one’s life will be difficult. It can be hard to find someone who is an expert in profound giftedness, and working toward that understanding with a therapist who accepts the importance of profound giftedness can work. After all, it is impossible to buy pants without understanding how tall someone is, and it is very difficult to engage in therapy without understanding the implications of giftedness and profound giftedness.

Finally, a profoundly gifted child’s relationship with their parents is especially important as well. Parents have only a few short years to develop positive relationships, and once children leave the home, the relationship is all they will have left. Building a strong, balanced, and positive relationship that does not abdicate the role of parent in favor of only positive (“friend”) relationships is necessary. Therapy can foster these relationships, and consistently setting only those limits that parents can and intend to enforce will be important in that process.

Tips

  1. In therapy, it is important to set clear goals and that will allow both therapist and client to assess progress. The more specific the goals, the easier it is to assess progress. Jointly setting smart goals (specific, measurable, attainable, realistic, and timely) can help.
  2. Therapy can be used as a preventative measure, not just to address problems. I think it’s important for all children to have a connection with a therapist in case problems arise.  Some families use psychologists like me in the same way they use a primary care doctor, checking in every six to twelve months or as needed in between. The assessment of problems and their frequency, intensity, and duration (FID) are important to judge the necessity of more frequent meetings. A psychologist can determine whether the FID is indeed atypical and requires more intensive therapeutic work.  Looking at the one to ten scale I mentioned, when numbers are in the area of concern (low or high depending on how you use the scale), it is an indication that therapy can be helpful.
  3. Remember that it is not unusual for profoundly gifted teenagers to prefer associating with adults. While it is beneficial to develop age-appropriate friendships when possible, all relationships and connections with others, regardless of age, are important. Not all my friends are my age, and that is true for many of us.
  4. Regarding confidentiality, I try to be upfront with clients and parents about confidentiality and its limits. They clearly understand what is and is not confidential. The older the client, the less parents get to know. That said, parents are usually footing the bill, so they get information about how things are going, general topics of sessions, and progress updates. I try to flow with the client’s resistance when interventions don’t work, or they don’t even try. “Oh, that didn’t work?  HUH, interesting. How can we tweak it so it might? What else can we try?” Now, if I get a couple of evident lies in a row, I’ll confront it and redirect to why we’re meeting.
  5. In therapy, the label is sometimes less important than the needs—I don’t care what we call it as long as we identify how we are going to help it. That said, accurate understanding of what it is may be necessary to finding the right interventions. And, having a label may also demystify it for the child. So, really, it’s an individual question. What is going to help this kiddo the most? Do we need to name it before we can tame it? Or, do we have an idea of the needs and can intervene based on that?
  6. To address impulsivity, start with the ideas in Smart but Scattered and try playing games like Simon Says or any games that involve turn taking. Emphasize to the child what the goal is—we’re working to GET BETTER AT…waiting your turn, not interrupting, listening, etc.—before playing. Remind them during the game, “Remember, that’s what we’re working on.” Gentle redirection and guidance help them have fun while learning and practicing. Sometimes, however, the behavior is a “can’t” not a “won’t” and medications or more intensive work are needed. Evaluation can help clarify that. There are some therapeutic approaches that can help as well, but it is difficult with younger children. In those cases, working on parent management, perhaps with something like PCIT can help. With older children, CBT with a focus on executive functioning or an executive functioning/ADHD coach may work.
  7. Empirically supported treatment options are important. They are good starting points, but each child is a subject pool of one, and it can take work to find what will help that client. Which tools will work best? That’s why we work so hard to find the right carpenter.
  8. When PG kids have concerns about their physical appearance or seem to have low self-esteem, therapy is appropriate, especially when it interferes with daily functioning. Both ACT and traditional CBT have proven effective with these types of difficulties. Correcting distorted thinking and accepting oneself is hard, but possible.
  9. When a child resists therapy, thinking it’s a waste of time and their intellect helps them “see through” what a therapist is trying to do, what can you do? While it can be difficult to find a therapist bright enough to see through your son’s challenging behaviors, this is where the relationship between therapist and client becomes really important. Having an honest conversation about what a kid wants to change is necessary. If he “knows the right answer,” what keeps him from using the tools to see the results? Whatever the kid is doing isn’t working (that’s why they are in therapy) and maybe they can start to see that there’s a better way.  Often, in these cases, the client is either not trusting the therapeutic process or the person providing it. Until that is resolved, progress in unlikely.
  10. A question was raised about preventing suicide. My advice is to nurture a positive self-view and help the child create a life worth living. While there is no data suggesting that PG kids are more likely to take their own life, their asynchrony renders them more vulnerable to potential challenges and I believe it comes back to the issue of understanding, accepting, and addressing the “PG-ness.” The better those are done, and the better the educational needs are met, the fewer difficulties.

Additional questions that didn’t get answered or weren’t addressed in the above tips:

Q: If you know that you already have a 2e kid and there is school paperwork to support that there is a learning difference, is there any reason to do additional evaluation in their junior or senior year before heading off to college?

A: The only reason to do additional assessment in this situation would be if documentation is needed to provide accommodations on standardized testing such as the ACT or SAT.  Most colleges will accept documentation from high school to support learning needs in college.  Some colleges will request additional evaluation if none has been done within the past three years, but if the documentation is consistent and long-standing, you may not have to do anything additional. It can depend on the school, though, so I recommend asking that when applying or definitely by the time of acceptance.

Q: How can we balance a desire from our child to take a break from therapy vs. us seeing that there are still lots of things to be worked through.  Saying no can raise feelings of resentment and pushback.

A: Perhaps setting interim goals for break points will be helpful.  For example, consider saying something like, “Hey, let’s work on getting better at this and if we can see progress in this area, perhaps we can take a short break from therapy before re-engaging to work on this other problem.” Sometimes, the positive changes will spiral out from that one. From the therapist perspective, my response to the kid who wants to stop when parents don’t is usually something like, “Look, your parents gave us a roadmap to you never coming here. Let’s work on this—if we succeed, it’s a win-win-win. Your parents are happy, you don’t have to come, and your parents think I am the greatest therapist ever!” I don’t always get buy in, but I usually get a chuckle.

Q: How do you discuss and disclose information about giftedness when it may affect siblings who have not been identified as PG? How do you deal with the special treatment or attention sometimes demanded by the profoundly gifted child and the imbalance (or lack of perceived fairness) that can create in the home? What do you tell the other children?

A: We discuss this in our chapter on relationships in A Parent’s Guide to Gifted Children, second edition.  Fair does not mean equal—we don’t buy every kid both new shoes and pants when one kid needs pants and the other needs shoes. We address needs and they differ and making that implicit information explicit through conversations is important.  That said, it is important to discuss each child’s value as they bring it to the table, regardless of the area of strength.  All children, whether profoundly gifted or not, add value to the family and reflecting on that child’s value as it relates to the family is important.  Each child has strengths—help each child develop their strength areas.  Celebrate individual accomplishments as they relate to the family and reflect on the value each accomplishment adds to the family. See our book for more information and ideas on this.

Resources

A Parent’s Guide to Gifted Children: A Resource for Caregivers and Advocates (second edition) by Amend, Kircher-Morris, and Gore.

The Gifted Kids Workbook by Heather Boorman.

Gifted and Distractible by Julie Skolnick.

Perfectionism: A Practical Guide to Managing “Never Good Enough” by Lisa Van Gemert.

The Neurodiversity Podcast with Emily Kircher-Morris

Speaker Bio:

Edward R. Amend, Psy.D., a licensed clinical psychologist at The Amend Group in Lexington, KY, focuses on the social, emotional, and educational needs of gifted, twice-exceptional, and neurodivergent youth, adults, and their families. Dr. Amend is co-author of the revised edition of A Parent’s Guide to Gifted Children: A Resource for Caregivers and Advocates, as well as other award-winning books, chapters, and articles about gifted children. He presents nationally and internationally, and his service has included various leadership roles with NAGC, SENG, KAGE, and The G WORD film’s Advisory Board.

Permission Statement

This article is provided as a service of the Davidson Institute for Talent Development, a 501(c)3 nonprofit dedicated to supporting profoundly gifted young people 18 and under. To learn more about the Davidson Institute’s programs, please visit www.DavidsonGifted.org.

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