Psychotherapy For The Gifted
Jerald Grobman M.D.
Madelon Sann L.C.S.W.

All sessions are on Zoom, join easily from any location.

Case Study: Learning Disability in a Gifted Adolescent Boy – Eric


Was he a twice-exceptional adolescent – a gifted adolescent with a co-existing writing disorder, disability, or challenge? 

Was he a gifted adolescent with a  learning inhibition? 

Read this case study to learn how to tell the difference between the two. 

Why is This Important? 

The twice-exceptional syndrome is defined as a gifted individual with a separate co-existing learning “challenge“, disability, or disorder. However it is described, the learning challenge disorder or disability  is assumed to be caused by an as yet undetermined primary cognitive /neurological defect.

Learning disorders or disabilities cannot be cured. They can last a lifetime and can only managed by remediation techniques – workaround strategies that compensate for the disorder. They can undermine a gifted adolescent’s sense of  sense of self-esteem, and giftedness and can result in anxiety, depression, and behavior problems. 

Learning inhibitions are caused by unresolved emotional issues that interfere with aspects of the learning process and its associated executive functions. Inhibitions can be removed when the unresolved emotional issue is worked through.

In Eric’s case, once his unresolved emotional conflict about separation was identified, he was able to process it in therapy and the writing inhibition disappeared. 

A Gifted Adolescent with an Emotionally Based Learning Disability

The example is a greatly abbreviated version of a more complete clinical case report that will be included in a forthcoming paper “ A New Look at the Psychology of the 2e Syndrome: Understanding and Treating It.” The paper will include a comprehensive literature review and a detailed discussion of the complex nature of the 2e phenomenon. 

Why did Eric come for Therapy? 

Eric was 13 ½when he was referred for therapy. Since his parent’s divorce, he had been living with his mother. Intelligent, sensitive, and cooperative despite their divorce, they felt Eric needed therapy for several reasons. Theirs was an unusual example of anticipating emotional problems rather than waiting for them to develop. 

Entering a Competitive High School 

The high school Eric was about to enter was much closer to his father’s house than his mother’s and because his mother was returning to work full-time, Eric and his parents felt it made sense for Eric to leave his mother’s home and move in with his father. The new school was a destination for the city’s elite students and had a reputation for being pressured and competitive. Every parent felt that to be a successful student there required major emotional and intellectual adjustments. Eric’s parents also felt he had never really “emotionally processed” their divorce. Eric, on the other hand, was “up for” the challenge of the new school and felt that his parent’s divorce had been “no big deal”. He couldn’t see the point of therapy. 

Was Eric Gifted? 

Eric was identified as gifted in grade school: he consistently got very high grades in all areas with very little effort. In middle school, his teachers observed that he had a “special feel” for math and science. Completing written assignments was not quite so easy but he was always complimented on his ability to handle complex material with an unusually effective style. Good-looking, popular, and confident Eric objected to being sent to a therapist. 

Academic and Social Problems Begin 

Within several weeks of starting high school, it was clear Eric was emotionally and academically overwhelmed. Initially excited by the challenge of the city’s best school, he wasn’t sure he could handle it. In middle school everyone knew he was gifted in this tough school nobody seemed to care. It was a big noisy place with an aggressive feel. In the first few weeks, kids were already talking about how hard it was to get into the best colleges. 

For the first time in his life, Eric found himself doing homework. The pace in classes was so intense that the material was just not going into his head the way it used to. Without taking notes, he wasn’t sure he could keep straight the details from different subjects. To make matters worse, he didn’t have any friends. Because he had been so popular, he was used to classmates approaching him for friendship. Now he felt confused and lost. 

Therapy Begins to Help 

Several months into the treatment he softened his independent attitude and was willing to take suggestions for how to reach out to classmates. Finally, when some of the “jocks” discovered he was a good athlete, they invited him to play on their basketball team. Before long he had a girlfriend. 

The Writing Problem Emerges 

By second semester, Eric was getting top marks in math and science. Once again excellent results came with little effort. His confidence and self-esteem were returning. However, his grades in English and History were stuck at the C level. The difficulty seemed to be with the writing. He just couldn’t seem to get started. He procrastinated. As deadlines approached, he began to have panic attacks. He could hardly believe this was happening to him. He was forced to request extensions. It was an odd problem because when his work was returned, it was invariably with many compliments. Over and over again it was “excellent work, interesting insights, wonderful style but because of 2 extensions, I can’t give you more than a C”. Praise for one assignment never seemed to make approaching the next one any easier. He wondered if he had a short-term memory deficit. Never needing to “break a sweat” as he put it, was he rebelling against the preparation and hard work now required to get excellent grades? Or was it possible that his gifted abilities had masked a longstanding learning disability — now revealed in a more demanding environment? 

Neuropsychological Testing Indicates a “Language-Based Learning Disorder”: Attempts at Remediation Fail 

A series of neuropsychological tests did in fact reveal a “language-based learning disorder”. But months of efforts at remediation and attempts to master compensation strategies were largely ineffective. He described the sessions with the learning specialist as boring and said his concentration began to fall apart within 15 minutes of starting. I asked if he was embarrassed about his diagnosis but he denied it and said he was trying his best to work at it his confidence began to fade as he became increasingly discouraged. He wondered how smart he really was. I asked if there was something about the process of writing that presented some special uncomfortable meaning for him. He didn’t quite get what I meant. Soon I stopped exploring these issues with him and concentrated on being supportive and empathic about how hard all of this must be for him. 

The Turning Point: The Writing Disorder Disappears 

A dramatic experience in a summer writing course clarified what the writing disability was all about. It was a twice-weekly course with brief assignments due at the end of each week. The teacher was a pleasant supportive woman who freely granted extensions when necessary. This of course was a great relief to Eric. Within several weeks he distinguished himself as one of the best writers. But, as usual, each assignment required an extension. The teacher wondered about the need for repeated extensions – was he a perfectionist? Eric told her about his disability. She emphasized that he was an excellent writer and she couldn’t imagine why he was worried about the quality of his work. Perhaps it was something else but neither of them could figure it out. 

Several weeks before the end of the course the teacher announced she would give no extensions for the last assignment. With 3 days left, Eric had an anxiety attack and pleaded for an extension. At first, the teacher refused but, sensing his mounting panic, she agreed to an overnight extension but, as he was the only one receiving this, he needed to promise to keep it a secret from his classmates. What happened next completely stunned Eric. 

As if in a trance of crystal clear thinking he wandered into an empty classroom, opened his laptop, and although he had spent days of completely unproductive thinking about it wrote out his assignment within 30 minutes. Astonished, he realized he needed to make only several corrections. After completing these, he e-mailed the essay to his teacher only 1 hour late. As expected, she congratulated him on his fine work. 

Processing How This Happened 

As we went over this remarkable experience in session, Eric reflected on how his teacher gave him special consideration and began to cry. He found himself thinking about his parent’s divorce. For the first time, he could acknowledge how sad it was. He talked about how he was completely unaware of this sadness. “I guess I thought I was smart enough to handle it myself.” As one memory led into another, he recalled how much fun he and his mother used to have spelling writing, and reading. “ It all started when she gave me foam letters to play with in the bathtub. We played with them making real words or silly words. Then words became sentences then sentences became little paragraphs. As I got older, the writing continued to be a special part of our relationship. She would help me critique my essays and reports. We debated word choice, sentence structure, and paragraph sequencing”. 

Further emotional and insightful sessions helped Eric understand his difficulty with time management and the need for extensions. It all seemed related to the special unhurried time he once had with his mother – a time spent without deadlines or pressured restrictions – a part of his childhood that he was not prepared to let go – and a part that was prematurely interrupted by divorce and a need to move in with his father. The secret extension he got from his teacher, temporarily gratified his continued need for special time and broke through his “disability” to give him a moment of a kind of cognitive clarity.  

Understanding the Emotional Basis for His Learning Disorder 

Now Eric also began to understand why he had so much difficulty with learning the techniques of remediation and strategies of compensation. Mastering these would mean he would no longer need to depend on his mother or teachers for special attention. Successful use of these would also mean that his giftedness would be free to operate across all intellectual domains. Would this mean his grades would put him out in front of all his friends? Would it mean that giftedness would cause him to be isolated lonely and unhappy? He began to see the appeal of retreating into the safety of a learning disability. 

Eric’s therapy continued through high school and periodically through college. After graduation, he landed an impressive entry-level job with a management consulting firm. His written assignments all require quick responses they are all turned in on time – sometimes early.  

Understanding and treating the 2e syndrome requires more than an appreciation of how giftedness can mask learning disabilities, learning disabilities can restrict giftedness or the two may simply neutralize each other. In this case – typical of many we have seen over the years – even though the learning disability was diagnosed neuropsychologically it was primarily emotionally based. The emotional issues were unresolved dependency needs and conflicts about the power of giftedness itself. 

Adding a psychodynamic approach to other assessments and treatments can help a clinician better understand a particular 2e student and make other cognitive, and behavioral interventions more effective. 

Discussion and Takeaway 

Emotionally based learning problems in gifted individuals are often misdiagnosed as the twice exceptional syndrome – gifted children or gifted adolescents who have what are assumed to be neuro/cognitively based learning disabilities, disorders, or “challenges”. 

The alert therapist  is tipped off when the remediation and compensation strategies fail to work. 

A careful history of the nature of an individual’s giftedness, family dynamics, and circumstances can lead to how and why specific  unresolved emotional issues have  blocked a gifted individual from using his gifted abilities in all aspects of the learning process.

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Jerald Grobman M.D.

Madelon Sann L.C.S.W.​

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