Neurodiversity and the Medicalization of Twice Exceptional People

Twice Exceptionality

‘Twice exceptional’ is a term used to describe individuals who are both gifted and have some form of disability. Although these traits are often viewed as opposite ends of the spectrum, this is an incorrect interpretation. Many conditions, such as Autism Spectrum Disorders (ASD), specific learning disabilities (SLD), ADHD and emotional disturbances (ED) can be combined with some form of giftedness. Studies have shown, for example, that as the brains of people with reading disabilities are developing, as the left hemisphere language areas become prone to impairments the right hemisphere areas could grow, leading to nonverbal gifts such as creativity, problem solving or intuition. This leads there to be many sub-populations of twice exceptional people such as artistically gifted with a learning disability, or academically gifted with an emotional or behavioural disorder.

The term “gifted” was first introduced in 1972 and, although it has no universal definition, it is estimated that roughly 5-20% of the general school population falls into this category. In 2004, the reauthorization of the Individuals with Disabilities Education Act (IDEA) recognized that those people who are considered gifted may also have some form of disability that limits them in other areas. Unfortunately research on this intersecting group is limited and surveys find that 60.14% of school psychologists had little to no familiarity with twice exceptionality. Often these individuals struggle and, due to either their gifts masking their disabilities or their disabilities masking their gifts, they often go unidentified.

In schools, teachers are found to be more likely to refer a twice exceptional student to counseling services rather than to gifted education. This is despite other studies showing that gifted educators are in the best position to advocate for these students. Membership in a gifted program has also been shown to increase self confidence and build communication skills, even for students who may struggle with the level of work. Even if a twice exceptional students gifts are recognised, their disability may be ignored since gifted students are rarely assessed by psychologists. This can lead to these student’s not being given the opportunity to reach their full potential and strengthen the skills they have while finding ways to accommodate weaknesses. One study examined five twice-exceptional students and found that their motivation is strongly tied to their relationship with their gifted teacher. Out of these five students, three had been removed from the gifted program with only one returning. This was mostly credited to a lack of accommodation for the student’s disability.

Race and Twice Exceptionality

In American schools, African American children, particularly boys, are overidentified as having a disability than children of other races. In particular, these students are 2.14 times more likely to be diagnosed with an emotional and behaviour disorder. This is often due to teachers difficulty understanding cultural or linguistic differences, but can also be caused by bias in the standardized assessments which are used to identify these students. This means that African American students are more likely to be in special education classes, which has been shown to cause these students to have personal and social issues related to race.

In gifted programs, African American students are underrepresented by nearly 50% and are much less likely to be referred to these programs than Asian or white students. This is due to stereotypes surrounding the characteristics needed to be considered gifted, and standardized testing which is normed on white, middle-class students has been shown to do poorly when evaluating African American students. In some cases alternative performance-based assessments are being used, and have been found to identify higher percentages of low income and minority students. Even if these students make it into gifted programs there are many factors which can make this a difficult experience. Gifted African American students often feel underrepresented in the curriculum which can cause them to dissociate from the school. When evaluating the effects of socioeconomic status on the performance of gifted students, it was found not to have an effect on white students who were found to integrate into and make friends in their gifted classes. On the other hand, low-income African American students were often seen as “loners” by their gifted teachers because they tend to have more friends in the regular classes and interact less with their gifted peers. They can also be accused of “acting white” by peers which could cause them to underperform in order to fit in. Despite these setbacks, the majority of students perceive the gifted program as having a positive impact, and African American students in lower socioeconomic groups were found to be the most appreciative of the opportunity to be in these classes.

With the already small amount of research done on twice exceptionality, even less is done on the intersection of race, giftedness and disability. Research on giftedness combined with emotional and behaviour disorders is also particularly limited, therefore with so many African American students placed in this category they are at a disadvantage. Due to the combination of race and disability, twice exceptional students who are African American are even more likely to be overlooked by teachers for gifted education, and to remain unidentified when using standardized testing. They may also be faced with a minority of similar peers in their gifted and special education classes which can be isolating and cause them to filter their racial identity through their identity as a disabled or gifted person. Overall, studies show that when these students find their cultural identities to be a source of strength, this gives them the tools to develop a positive academic identity and to excel in these programs.

From Medicalization to Neurodiversity

Often when faced with an individual who is neurologically different than the norm, it is standard to consider them to have some for of disability or disorder. The Diagnostic and Statistical Manual of Mental Disorders categorizes these characteristics and focuses on fixing or curing these deficits. Although there are often difficulties associated with atypical neurological development, it is argued that in many cases these problems are not caused by the disorder but by the expectations of a society which considers neurotypical brains to be the only “normal” brain. Many autists complain of living in an autism-incompatible or autism-phobic society which undermines their abilities to reach their full potential.

The neurodiversity movement was started by online Autistic groups in the 90s, and aims to encourage people to see neurological “disabilities” such as Autism and dyslexia as natural variations in neurological development. This belief is driven by the fact that 90% of variance in autism can be attributable to genetic factors, which suggests that this a normal variation and must have been preserved by some evolutionary benefits. While 75% of people diagnosed with autism have intellectual disabilities, the remainder have average or better IQs and are referred to as “high-functioning”.

There are two main concepts which are key to the creation of an inclusive, neurodiverse society. First, those who are not neurotypical should not be seen as disabled or having a disorder, but rather should be seen as a normal human difference. These people can be seen as a vulnerable group much like those of gender, race and class which should have their differences respected the same as other human differences. The second part is to recognise the benefits to society of diversity, including having a diverse set of neurological perspectives. As more people who are twice exceptional are recognised, their gifts can be encouraged and respected so that both the individual and society as a whole can benefit from these perspectives.