Many individuals who are gifted have been described as having “overexcitabilities” (Dabrowski, 1964). This may be seen in sensory sensitivities (especially tactile and auditory input). This should be considered when assessing the ability to modulate sensory input (an over- or under- response to input; in this population, an over-responsiveness to tactile and auditory input is more common, but an under-responsiveness to vestibular input may be seen). When these sensory sensitivities are extreme, they may impact attention, especially in stimulating environments, such as large groups or novel settings; self-regulation; and daily living skills. They can impact the ability to tolerate a healthy diet (pickiness about food textures) or the clothing they are comfortable wearing (difficulty with socks, tags, shirts, pants). In addition, the OT should assess the ability to discriminate sensory input. Difficulties with efficient sensory discrimination (especially proprioceptive and vestibular input) may result in motor difficulties or dyspraxia (difficulty in organizing and planning non-routine motoric challenges).
During the assessment, the therapist needs to look at both quantitative and qualitative aspects of the individual’s performance. Many individuals who are gifted can use their cognitive abilities to perform specific isolated tasks, but they may be expending excess energy and effort to complete those tasks and mask the challenges. None of us can work at 100% all of the time. This can often be the case when an individual is described as being very inconsistent in performance. At times, the way the task is completed may be more important than the end product. If it looks unusual, this may be a signal to look again.
When doing an assessment, the OT is only getting a snapshot of the individual. Part of the assessment should include parent input about the child, what is seen in other environments and the concerns. This might be a questionnaire such as a “sensorimotor history” or a more formal tool such as the Sensory Profile or Sensory Processing Measure.
Similarly, if handwriting is an issue, scores in the “normal” range may be a relative weakness, since the child who is gifted may be thinking 3 times faster than the hand can write. Consider working on handwriting anyway, but also consider assessing if the child has the fine motor skills for keyboarding and, if so, then focus on learning keyboarding skills. In the long run, this may be a much faster way to get the ideas down on paper.
An occupational therapist should be looking to see if issues are impacting the individual’s ability to participate in functional, daily life tasks. We all have our strengths and weaknesses, but a weakness that does not impact functioning may not need intervention. However, excess stress, frustration, or effort to complete tasks can be valid reasons to see if assistance with tools or strategies might be helpful to make things easier. This might take the form of a short course of therapy (3 months or less) or a handful of consultation sessions (1-5 sessions) to provide input for setting up a really good home program (e.g. Sensory Diet, a typing program).
Individuals who are gifted often do best when cognitively engaged. Many OTs who work with young children may not be used to this. They may instead try to “trick” the individual into participation in the tasks they want to practice. Parents should try being explicit with the therapist about what you think might work best and therapists should listen to the parent’s suggestions. There are some good cognitive/behavioral programs for self-regulation based on sensory issues that we have found work well with this population, including The Alert Program for Self-Regulation, Zones of Regulation, and A “5″ Could Make me Lose Control!