The Gift Was Hiding the Difficulty

What the research found

This is a case report, not a trial. Lee Sook Huey and colleagues, working across universities and a teaching hospital in Malaysia, describe two children in close clinical detail. The whole study rests on two people. That is worth stating plainly at the outset, because it shapes everything the paper can and cannot claim.

The first child, called AD, is a thirteen-year-old boy. He was referred to a psychology clinic after his parents brought him to a psychiatrist for low mood and suicidal thoughts, following prolonged bullying at boarding school. On the Wechsler Intelligence Scale for Children (Fifth Edition), a standard measure of cognitive ability, his full-scale IQ was 129, placing him at the 97th percentile. His non-verbal reasoning was higher still: a Fluid Reasoning score of 144 and a Visual Spatial score of 135, both above the 99th percentile. He was, on the numbers, gifted. He had also been a top scorer in primary school. Yet a battery of autism rating scales, completed by clinician, father, and teacher, converged on a diagnosis of autism spectrum disorder. His parents had spent years reading the difficulty as bad behaviour rather than a condition.

The second child, EE, is six. He was diagnosed with autism at three. His full-scale IQ was 128, again around the 97th percentile, with a Visual Spatial score of 151, at the very top of the scale. But his profile was uneven in a way that matters. His verbal comprehension sat at exactly average (100), and his vocabulary sub-score was strikingly low. The assessment also identified co-occurring ADHD of the hyperactive-impulsive type. Here was a child solving secondary-school physics problems who could not stay in a mainstream classroom, and who was, in the end, removed from his school.

The paper’s central observation is what the authors call the twice-exceptional paradox. High ability and genuine disability sit in the same child, and the ability tends to hide the disability. A bright pupil who compensates does not look like a pupil in trouble, so the trouble goes unnamed. The authors note that people with autism are more likely than the general population to score in the superior range on IQ tests, which means giftedness and autism co-occur more often than a casual observer might assume. In both cases here, the compensation delayed the right kind of help.

On what helped, the report is modest and honest. AD’s parents attended four weekly hour-long psychoeducation sessions and shifted toward a strength-based, more collaborative parenting style. The authors report that AD became happier, made friends, took up new activities, and repaired his family relationships. EE’s parents received similar guidance and a recommendation to change his schooling. These are described outcomes from clinical notes, not measured results from a controlled comparison.

What it means for you and your child

Read this study for what it is: a careful, sympathetic portrait of two children, offered to raise awareness among parents, teachers, and clinicians. It is not evidence that a particular programme works. Two children cannot establish that. There was no comparison group, no follow-up scores, and no way to separate the effect of the parenting sessions from time, medication, changing schools, or the family’s own resolve. The improvements are real to those families, but they are anecdote, not proof. The authors themselves frame the work as illustration, noting that every individual’s situation is unique.

What the report does illustrate well is a pattern worth recognising in your own child. A high test score does not rule out a genuine learning or developmental difficulty. It can conceal one. Both boys had jagged cognitive profiles: soaring visual and reasoning scores alongside markedly weaker verbal or processing scores. A child can be brilliant at pattern and puzzle and still struggle badly with putting words to ideas, staying seated, or reading a social situation. If the overall number looks reassuring, the gaps underneath it can go unexamined for years.

The practical lesson is about the shape of the assessment, not the headline figure. Both diagnoses emerged only because clinicians looked at the whole picture: a clinical interview, direct observation, objective attention and executive-function tasks, and standardised rating scales gathered from parents and teachers. A single IQ figure would have told you AD was gifted and stopped there. It took the fuller assessment to reveal the autism sitting beside the gift. If something about your child does not add up, the strong marks alongside the persistent struggles, that discrepancy is itself the signal.

There is also a caution here about interpretation. Bullying, low mood, and defiance are easy to read as the whole problem, or as simple misbehaviour. In AD’s case they were downstream of an unrecognised condition and, the authors suggest, of a harsh response to it. Naming the underlying difficulty changed what the family could do about it.

Finally, a note on culture and setting. This research comes from Malaysia, where autism and ADHD are classified under learning disabilities and where, the authors argue, twice-exceptional children fall through the gaps in policy. The specifics of provision differ from those in the United States or Britain. The underlying human pattern, ability masking difficulty, travels. The details of what to do about it are a conversation to have with clinicians and educators who know your child and your system.