Wechsler profiles in referred children with intellectual giftedness: Associations with trait-anxiety, emotional dysregulation, and heterogeneity of Piaget-like reasoning processes

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Official Journal of the European Paediatric Neurology Society

Original article

Wechsler profiles in referred children withintellectual giftedness: Associations with trait-anxiety, emotional dysregulation, andheterogeneity of Piaget-like reasoning processes

Fabian Gu�enol�e a,b,*, Mario Speranza c,d, Jacqueline Louis e,Pierre Fourneret e,f,g, Olivier Revol e, Jean-Marc Baleyte a,b,h

a CHU de Caen, service de psychiatrie de l'enfant et de l'adolescent, avenue Clemenceau, 14033 Caen Cedex 9, Franceb INSERM, unit�e 1077, Neuropsychologie et neuroanatomie fonctionnelle de la m�emoire humaine, avenue de la cote de

Nacre e CS 30001, 14033 Caen Cedex 9, Francec Hopital Mignot, service de psychiatrie de l'enfant et de l'adolescent, 177 rue de Versailles, 78150 Le Chesnay, Franced Universit�e de Versailles-Saint-Quentin-en-Yvelines, facult�e de m�edecine, 2 avenue de la source de la Bi�evre,

78180 Montigny-le-Bretonneux, Francee Hospices Civils de Lyon, service hospitalo-universitaire de psychiatrie de l'enfant et de l'adolescent, HopitalFemme-M�ere-Enfant, 59 boulevard Pinel, 69500 Bron, Francef CNRS, unit�e 5304, Laboratoire sur le langage, le cerveau et la cognition, 67 Boulevard Pinel, 69675 Bron Cedex,

Franceg Universit�e Claude Bernard Lyon-1, facult�e de m�edecine Lyon est, 8 avenue Rockefeller, 69373 Lyon Cedex 8, Franceh Universit�e de Normandie, facult�e de m�edecine, avenue de la cote de nacre, 14032 Caen Cedex 5, France

a r t i c l e i n f o

Article history:

Received 25 January 2015

Received in revised form

16 March 2015

Accepted 17 March 2015

Keywords:

Anxiety

Child, Gifted

Deficient emotional self-regulation

Abbreviations: AB, aggressive behaviour; Abehaviour checklist; CBCL-DP, child behavioment scale; NVLD, nonverbal learning disabiSVPD, significant verbal-performance discre* Corresponding author. CHU de Caen, servi

France. Tel.: þ33 2 31 27 23 09; fax: þ33 2 31E-mail address: [email protected] (F

http://dx.doi.org/10.1016/j.ejpn.2015.03.0061090-3798/© 2015 European Paediatric Neuro

Please cite this article in press as: Gu�enociations with trait-anxiety, emotional dysPaediatric Neurology (2015), http://dx.doi

a b s t r a c t

Background/purpose: It is common that intellectually gifted children (IQ � 130) are referred to

paediatric or child neuropsychiatry clinics for socio-emotional problems and/or school

underachievement or maladjustment. Among them, those displaying developmental

asynchrony e a heterogeneous developmental pattern reflected in a significant verbal-

performance discrepancy (SVPD) on Wechsler's intelligence profile e are thought to be

more emotionally and behaviourally impaired than others. Our purpose was to investigate

this clinical dichotomy using a cognitive psychopathological approach.

Methods: Trait-anxiety and emotional dysregulation were investigated in two groups of

referred gifted children (n ¼ 107 and 136, respectively), a pilot-study of reasoning processes

on extensive Piaget-like tasks was also performed in an additional small group (n ¼ 12).

D, anxious/depressed; AP, attention problems; ASD, autism spectrum disorders; CBCL, childur checklist-dysregulation profile; IQ, intellectual quotient; LTDS, logical thought develop-lity; R-CMAS, revised-children's manifest anxiety scale; RHI, reasoning homogeneity index;pancy.ce de psychiatrie de l'enfant et de l'adolescent, avenue Clemenceau, 14033 Caen Cedex 9,27 24 03.. Gu�enol�e).

logy Society. Published by Elsevier Ltd. All rights reserved.

l�e F, et al., Wechsler profiles in referred children with intellectual giftedness: Asso-regulation, and heterogeneity of Piaget-like reasoning processes, European Journal of.org/10.1016/j.ejpn.2015.03.006

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Dysregulation profiles

Intelligence

Psychometrics

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Results: Compared to those with a homogenous Wechsler profile, children with a SVPD

exhibited: 1) a decreased prevalence of social preoccupation-anxiety (11.1% versus 27.4%;

p < 0.05); 2) an increased prevalence of emotional dysregulation (58.7% versus 41.3%;

p < 0.05); and 3) an increased prevalence of pathological cognitive disharmony on Piaget-

like tasks (87.5% versus 0.0%; p < 0.05).

Conclusion: The results support a clinical dichotomy of behaviourally-impaired children

with intellectual giftedness, with developmentally asynchronous ones exhibiting more

severe psychopathological features. This suggests that developmental asynchrony matters

when examining emotional and behavioural problems in gifted children and call for

further investigation of this profile.

© 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights

reserved.

1. Introduction

Although the whole population of intellectually gifted chil-

dren e i.e. children with an intellectual quotient (IQ) �130,

according to the main and most consensual definition1,2 e

displays no apparent increase in psychiatric morbidity,3e5 it is

highly common that certain of them are referred to paediatric

or child neuropsychiatry clinics for socio-emotional problems

and/or school underachievement or maladjustment.6e10 Such

children display internalizing behavioural and emotional

problems (self-focused problems reflecting overcontrol of

emotion and behaviour: anxiety,11 social withdrawal,12,13 low

self-esteem,14,15 or excessive perfectionism11), and also a

range of externalizing problems (acted-out problems reflect-

ing undercontrol of emotion and behaviour: psychomotor

instability, irritability, or aggressive behaviour, for exam-

ples10). Though little is known about the validity and diag-

nostic specificities of categorical mental disorders in this

specific population, the common observation of behavioural

problems in gifted children without an increased prevalence

of categorical mental disorders in the whole gifted population

suggests that it is heterogeneous,10,16 and also inclines to-

wards a dimensional psychopathological approach.10,17

A notion usually considered when interpreting socio-

emotional and educational maladjustment of gifted children

is developmental asynchrony,18,19 which designates a prob-

lematic pattern of heterogeneities frequently seen in the

development of gifted children, between cognitive, emotional,

and psychomotor levels. Psychometrically, developmental

asynchrony may be reflected on Wechsler's IQ tests in the

verbal-performance discrepancy,2 which quantifies the

cognitive imbalance between abilities in verbal and nonverbal

reasoning.20 Examination of the verbal-performance discrep-

ancy is the hallmark of Wechsler's intelligence profile anal-

ysis, with a value �15 being considered as significant and

indicative of an abnormal profile.20,21 A significant verbal-

performance discrepancy (SVPD) is seen in approximately

one quarter of gifted children,22 and was found associated

with social and school maladjustment.23 Some data suggest

that it is more frequent in gifted children who are clinically-

referred than others8,10,24 and, in a recent study using

l�e F, et al., Wechsler prregulation, and heterog.org/10.1016/j.ejpn.2015

Achenbach's dimensional approach of childhood psychopa-

thology,25 SVPD was associated with externalizing behav-

ioural problems and internalizing-externalizing mixed

behavioural syndromes.10 These data fit a hypothesis set by

Gibello,26,27 who schematized a psychopathological di-

chotomy of clinically-referred gifted children: a first andmain

category would include intellectually homogeneous children

who manifest internalizing symptoms and social maladjust-

ment in relation to precociously mature self-reflectiveness; a

second category is thought to comprise asynchronous chil-

dren, who early develop externalized or mixed behavioural

syndromes and display more severe psychopathological

mechanisms and disturbances.

The present paper reports three studies, which investi-

gated the hypothesis just mentioned by comparing psycho-

pathological profiles of clinically-referred gifted children with

and without a SVPD. Study one explores trait-anxiety and its

dimensions across Reynolds' model28; study two investigates

emotional dysregulation through Achenbach's dimensional

psychopathology25; and study three applies a clinical neo-

Piagetian approach of reasoning processes.29

2. General methodological information

The three groups of gifted childrenwere successively recruited

at outpatient child psychiatry clinics specialized in the psy-

chopathology of gifted children and through the private prac-

tice of pediatricians and psychologists, where they were

referred because of socio-emotional problems and/or school

underachievement or maladjustment. All children had a full-

scale IQ �130 on the French version of the Wechsler Intelligence

Scale for Children-Third Edition20; SVPD was defined as a verbal-

performance discrepancy �15. No child was diagnosed as

suffering fromany categoricalmental disorder of theDiagnostic

and Statistical Manual of Mental Disorders, fourth version revised,30

after examination by trained psychiatrists and psychologists.

The research was conducted in accordance to the decla-

ration of Helsinki and to the French law regarding research

involving the Human person. Parents of each child signed for

informed consent after having been informed about the

research and its purposes.

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Statistical analyses were performed with the software R

version 2.15.0 (http://www.r-project.org/); significance was set

at p < 0.05.

3. Study A: trait-anxiety

Trait-anxiety is the stable and general propensity for an indi-

vidual to experience anxious feelings and behaviours.31

Though it is mainly linked to the internalizing range of

emotional-behavioural problems, it is also considered as a

broadmarker of childhood psychopathology.32,33We used here

Reynolds' model of childhood trait-anxiety, as operationalized

in the Revised-Children's Manifest Anxiety Scale (R-CMAS).28

3.1. Material and methods

The studied group consisted of 107 children (27 girls and 80

boys), aged 8 to 11 (mean: 9.6 ± 1.4 years). As described in a

previous report,9 22 (20.6%) of these gifted children displayed

significant dimensional trait-anxiety according to the French

version of the R-CMAS.34

The R-CMAS is a 37-item self-assessment of trait-anxiety in

children and adolescents from eight to eighteen.28 It provides a

“Total Anxiety” score, and three dimensional sub-scores:

“Physiological Anxiety” reflects the somatic manifestations of

trait anxiety; “Worry and Oversensitivity” reflects anxious ru-

minations and anticipation of affective distress; and “Social

Preoccupation” reflects feelings of inferiority, insufficiency,

loneliness, disapproval and hostility from others. The dimen-

sional structure of the R-CMAS has been demonstrated in gen-

eral population samples,35 and also specifically in gifted

children.36 It has been confirmed within the French version, as

well as the scale's other psychometric properties.34On the basis

of results obtained ingeneralpopulation samples, the FrenchR-

CMAS displays normalized scores with cutpoints for the

detection of trait-anxiety (�60.0 for the TA score and �13.0 for

the three subscales).34 Proportions of individuals whose score

or subscores exceeded these cutpoints were compared across

gifted childrenwithandwithoutaSVPD,usingchi-square tests.

3.2. Results

Results are summarized in Table 1. Forty-five of the 107 chil-

dren (42.1%) displayed a SVPD, which was in favour of verbal

intelligence in 43 (95.6%) of them; this group comprised 9 girls

and 36 boys. The non-SVPD group (n ¼ 62) comprised 18 girls

and 44 boys.

Proportions of a significant Total Anxiety score did not differ

significantly between children with and without a SVPD (22.2%

Table 1 e Proportions of children with significant R-CMAS sco

R-CMAS scores Gifted childr

With a SVPD (n ¼ 45)

Total anxiety�60 10 (22.2%)

Physiological anxiety�13 12 (26.7%)

Worry and Oversensitivity�13 14 (31.1%)

Social preoccupation�13 5 (11.1%)

Please cite this article in press as: Gu�enol�e F, et al., Wechsler prciations with trait-anxiety, emotional dysregulation, and heterogPaediatric Neurology (2015), http://dx.doi.org/10.1016/j.ejpn.2015

versus19.7%, respectively). Therewas significantlymorechildren

with a significant Social Preoccupation subscore among those

without a SVPD than others (27.9% versus 11.1%, respectively;

p < 0.05), other comparisons showed no significant difference.

3.3. Discussion

Prevalence of total trait-anxiety cases did not differentiate

children with and without a SVPD. Since trait-anxiety has

been considered as a broad marker of childhood psychopa-

thology,32,33 this result suggests that, among gifted children

who are clinically-referred, asynchronous and intellectually

homogeneous ones do not clearly differ as for their levels of

general psychopathology. Comparisons regarding the physi-

ological and worry/oversensitivity dimensions of the R-CMAS

neither distinguished both groups (though proportion of

physiological anxiety cases tended to be higher in the SVPD

group); what significantly differentiated the two groups was

social preoccupation only, which cases were significantly

more prevalent in the non-SVPD group.

The social preoccupation dimension of the R-CMAS model

refers to self-assessed feelings of loneliness, disapproval and

hostility from others, inferiority and insufficiency.28,34 The

results thus suggest that self-conception of such feelings is

less frequent in maladjusted children with asynchronous

giftedness compared to intellectually homogeneous ones.

Self-concept and its metacognitive prerequisites has been

found precociously mature in general samples of gifted

children,37e40 which have been hypothesized favouring mal-

adjustment and internalizing problems among them.14,37,38

Maladjusted children with asynchronous giftedness seem

not to fulfil this pattern, and it could be hypothesized that the

lower frequency of social preoccupation cases among them

may reflect a relative weakness in self-concept. Such a

weakness could keep them out of fully apprehending their

maladjustment, its social repercussions (loneliness, hostility

from others) and experiencing related negative feelings (feel-

ings of inferiority and insufficiency). This hypothesis calls for

investigations of self-concept and metacognition in develop-

mentally asynchronous children with intellectual giftedness.

4. Study B: emotional dysregulation

Emotional dysregulation is a subthreshold diagnostic category

proposed to reflect the common clinical cases of children who

display impaired self-regulation in the form of concurrent

disturbance in the domains of attention, trait and state mood

regulation (chronic irritability, mood instability and affective

storms) and control of behaviour (hyperarousal, impulsivity,

res across SVPD and non-SVPD groups.

en (n ¼ 107) c2 pevalue

Without a SVPD (n ¼ 62)

12 (19.4%) 0.131 0.72

8 (12.9%) 3.250 0.07

15 (24.2%) 0.632 0.43

17 (27.4%) 4.246 <0.05

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aggression).41e46 Though there is no absolute consensus

regarding the precise definition of the syndrome,41 Achen-

bach's dimensional approach allowed individualizing an

emotional and behavioural pattern, consisting of elevations

on the attention problems, aggressive behaviour and anxious/

depressed subscales of the Child Behaviour Checklist (CBCL47),

which has been termed the “dysregulation profile” (CBCL-

DP).42 Since children with distributed behavioural problems

frequently suffer from emotional dysregulation,46 clinically-

referred gifted children with a SVPD, who preferentially

exhibit mixed behavioural syndromes,10 may display a CBCL-

DP more frequently than gifted children with homogeneous

IQs.

4.1. Materials and methods

The studied group consisted of 136 children (41 girls and 95

boys), aged 8 to 11 (mean: 9.3 ± 1.0 years). As described in a

previous report,10 76 (55.9%) of these gifted children displayed

significant behavioural, emotional, and social problems ac-

cording to Achenbach's CBCL profile analysis.25,47 In parallel, a

group of children matched one-to-one with the “gifted group”

for age and sex was recruited in five primary schools for

establishing normative CBCL data.

The CBCL47 is an internationally recognized device for

psychopathological assessment in children and adolescents.

It consists of 118 statements about which parents are asked to

answer on a 3-point Lickert scale how much they apply to

their child considering the last sixmonths. It provides a “Total

score” for behavioural problems, which can be dichotomized

into “Internalized problems” and “Externalized problems”

scores. Based on factor-analyses which identified patterns of

co-occurring items,47 the CBCL also allows individualizing 8

narrow-band dimensional subscores: “Withdrawn”, “Somatic

complaints”, “Anxious/depressed” (AD), “Social problems”,

“Thought problems”, “Attention problems” (AP), “Delinquent

behaviour”, and “Aggressive behaviour” (AB). The French

version of the CBCL48 displays well-validated psychometric

properties,49 including discriminant validity between referred

and non-referred children50,51 and confirmation of its struc-

ture.52 Several definitions have been proposed to determine

eligibility for the CBCL-DP42; here, the AD, AP andAB subscores

were summed to form the CBCL-DP score,44 and 90th percen-

tile of normative scores distributionwas used as cutpoint, as it

is recommended for differentiating cases and non-cases in

French community samples.50,53 Proportions of individuals

with a CBCL-DP were compared between gifted children with

and without a SVPD, using the Chi-square test.

Table 2 e Proportions of childrenwith a CBCL e DP acrossSVPD and non e SVPD groups.

CBCLeDysregulationprofile

Gifted children (n ¼ 136)

With a SVPD(n ¼ 46)

Without aSVPD (n ¼ 90)

Present 19 (41.3%) 22 (24.4%)

Absent 27 (58.7%) 68 (75.6%)

c2 ¼ 4.11; p < 0.05.

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4.2. Results

Results are summarized in Table 2. Forty-six of the 136 chil-

dren (33.8%) displayed a SVPD, which was in favour of verbal

intelligence in 44 (95.7%) of them; this group comprised 10

girls and 36 boys. The non-SVPD group (n ¼ 90) comprised 31

girls and 59 boys.

Forty-one children (30.1%) displayed a CBCL-DP. There

were significantly more children with a CBCL-DP among those

with a SVPD than others (41.3% versus 24.4%, respectively;

p < 0.05).

4.3. Discussion

According to our results, SVPD may be linked to emotional

dysregulation in gifted children. Emotional dysregulation in-

cludes concurrent disturbances in the domains of attention,

trait and state mood regulation (chronic irritability, mood

instability and affective storms) and control of behaviour

(hyperarousal, impulsivity, aggression), and represents a

developmental heterogeneity entailing impairment in multi-

ple psychological domains.41,43,54 It appears early55 and is

stable across development,42 and is currently conceptualized

as a broad disorder of self-regulation,41,43 which constitutes

an early developmental risk marker for long-term affective

morbidity. Indeed, emotional dysregulation is a robust pre-

dictor of future negative outcomes, with a high risk when

entering adulthood for a series of affective disorders,43,46,56e58

temperamental and personality impairment,43,46,54,56 and

impoverished overall functioning.46 This may have some im-

plications when considering psychopathological prognosis

and treatment in referred children with asynchronous gift-

edness, and is consistent with the hypothesis they display

emotional and behavioural problems which may be early-

rooted in development.

5. Study C: Piaget-like reasoning processes

Whereas SVPD is a well-established indicator of cognitive

imbalance,59 it remains a relatively basic one, and it could be

useful in future research to characterize developmental

asynchronymore precisely.We report here a pilot-study using

Piagetian concrete and formal operational tasks,60 which

combination with IQ tests allows a deeper examination of

cognitive imbalance.

5.1. Material and methods

The studied group consisted of 12 gifted children (2 girls and

10 boys) aged 7 to 15 (mean: 10.5 ± 1.4 years), who were

administered the Logical Thought Development Scale (LTDS;

Echelle de D�eveloppement de la Pens�ee Logique61).

The LTDS is an extensive tool for the investigation of

reasoning processes in the child, based on the experimental

works and developmental model of Piaget and Inhelder.62 It

consists of five tasks, each of which involves a logical struc-

ture: invariance of physical quantities, permutation, proba-

bility quantification, spatial representation, and hypothetical-

deductive reasoning. The logical strategy used by the subject

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on each task is scored from one to five, depending on its level

within the developmental hierarchy of reasoning processes

(pre-operational, concrete operational A and B, formal oper-

ational A and B), which has been standardized in several

general samples.61 This allows calculating a reasoning ho-

mogeneity index (RHI),63 ranging from 0 to 100, which de-

creases with the number of spreads between levels in the

different logical domains. It reflects the subject's balance of

reasoning processes, with a RHI �70 denoting a significant

heterogeneitywithin them.64 Proportions of individuals with a

RHI �70 were compared between children with and without a

SVPD, using Fisher's exact test.

5.2. Results

Results are summarized in Table 3. Eight of the 12 children

(66.6%) displayed a SVPD, which was in favour of verbal in-

telligence in 7 (87.5%) of them; this group comprised 1 girl and

7 boys. The non-SVPD group (n ¼ 4) comprised 1 girl and 3

boys.

Seven children (58.3%) displayed a RHI �70. There were

significantlymore childrenwith a RHI�70 among thosewith a

SVPD than others (87.5% versus 0.0%, respectively; p < 0.05).

5.3. Discussion

The proportion of children with a RHI �70 was significantly

higher in the SVPD group than in the non-SVPD one. Though

very preliminary, this pilot result suggests that developmental

asynchrony in gifted children may correspond to a significant

heterogeneity of reasoning processes.

Gifted children display rapid knowledge accretion, which

reliance on experiencing contact with their physical and so-

cial environments thus has comparatively lessweight than for

intellectually ordinary children. Probably because a number of

skills are necessarily dependent on chronological age (such as

perception or motor function, for examples), this situation

seems to favour heterogeneity within reasoning proc-

esses.66e69 While some discrepancies of minor amplitude

within reasoning processes are indeed common among gifted

children during periods of their development67e70 (normal

cognitive disharmony64), they are quantitatively incommen-

surate with significant heterogeneity of reasoning processes

as operationalized in the LTDS, which represents a patholog-

ical cognitive disharmony.27,64,65 Moreover, normal cognitive

disharmony (70 < RHI < 9564) is typically provisional, as it al-

ternates with periods entailing homogeneous functioning.68,69

Indeed, it is thought that propensity for reasoning heteroge-

neity in gifted children is normally attenuated through

Table 3 e Proportions of children with a RHI ≤70 acrossSVPD and non e SVPD groups.

Reasoninghomogeneityindex

Gifted children (n ¼ 12)

With a SVPD(n ¼ 8)

Without aSVPD (n ¼ 4)

RHI�70 7 0

RHI>70 1 4

p < 0.05.

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heightened capabilities in analogical reasoning pro-

cesses,68,69,71 i.e. inductive processes relying on similarity

identification,72 which foster transfer between reasoning do-

mains.73,74 Following a neo-Piagetian framework, it could be

hypothesized that gifted children with a pathological cogni-

tive disharmony display lack of compensatory analogical

reasoning or other executive resources.

It must be acknowledged that small sample size limits here

statistical significance and generalizability of results. Further

investigation of reasoning processes in referred gifted children

with and without a SVPD would thus be necessary to confirm

its association with pathological cognitive disharmony.

6. General discussion

The three studies suggest that, within referred gifted children,

those with a SVPD exhibit 1) a decreased prevalence of social

preoccupation; 2) an increased prevalence of emotional dys-

regulation, and 3) an increased prevalence of pathological

cognitive disharmony, compared to those with homogeneous

Wechsler profiles. As a whole, this suggests that SVPD is a

relevant variable, which contributes distinguishing two sub-

groups within referred children with intellectual giftedness.

The first subtype e which may be slightly more frequent

than the second one according to our group sizes e includes

gifted children with homogeneous Wechsler profiles, who

manifest internalizing symptoms and social maladjustment

in relation to precociously mature self-concept.14,37,38 With

these children, extended self-concept would lead to a hyper-

monitoring of errors and adversity, and thus to overcontrol of

emotion and behaviour.68,69 This might be envisaged as a

childhood variant of Wells' cognitive-attentional syndrome,75

a cognitive-behavioural style characterized by extended

metacognition, with excessive self-focused attention and

threat-monitoring.76 Although the development of reasoning

processes in these children may be non-linear (as for gifted

children in general67e70), it remains relatively equilibrated,

without pathological cognitive disharmony. This whole

pattern could be subsumed under the term “metacognitively

maladjusted giftedness”.

The second subtype includes children with a SVPD, who

exhibit externalized or mixed behavioural syndromes,10

especially in the form of emotional dysregulation, and low

metacognitive skills. In this second subtype, more develop-

mentally driven, a broad disorder of self-regulation would

lead to pathological cognitive disharmony, of which SVPD

could be a reflect. In the field of psychopathology, SVPD is a

classical feature of Asperger syndrome,77 a high-functioning

form of autism spectrum disorder (ASD), with which

referred children with intellectual giftedness often share

characteristics78,79: verbal precocity, hyperlexia, hyper-

calculia, semantic hypermnesia, absorbing interests in

specialized topics (with limited social sharing), social with-

drawal, anxiety, excessive perfectionism, perceptive hyper-

sensitivity, and motor clumsiness. Intellectual giftedness is

common in moderate forms of ASDs,79e81 where this co-

occurrence has been conceptualized as one of “twice-excep-

tionalities”.81 These children with ASDs and intellectual gift-

edness exhibit both internalizing and externalizing

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behavioural problems.81 As ASDs are thought to represent the

high-level co-occurrence of continuously distributed quanti-

tative traits,82 it could be hypothesized that gifted children

with a SVPD, emotional dysregulation, and a pathological

cognitive disharmony, may be situated at the border of such

developmental atypicalities entailingmultiple impairments in

high-order cognitive functioning.83

SVPD is also a feature of nonverbal learning disability

(NVLD), or “Rourke's syndrome”, which clinical manifesta-

tions includes neuropsychological impairment in the domains

of arithmetic, spatial cognition, and nonverbal aspects of so-

cial cognition, together with a series of right-sided neurolog-

ical soft-signs.84,85 NVLD is conceptualized as a right-

hemisphere developmental dysfunction,85 and has also been

reported in patients with corpus callosum agenesis.86,87

Interestingly, NVLD entails chronic social maladjust-

ment,84,85 as it is the case for children in our research. It could

thus be addressed in future research whether or not a signif-

icant proportion of maladjusted children with asynchronous

giftedness display a NVLD, or similar neurodevelopmental

abnormalities involving mild interhemispheric disconnec-

tion/lack of hemispheric lateralization or right-sided neuro-

logical soft signs.

In our opinion, the intellectual pattern found in our sec-

ond subtype of maladjusted children with high IQ should not

be considered simply as intellectual giftedness, but rather as

a “high-functioning pathological cognitive disharmony”.

Thorough investigations of emotional regulation, self-

concept and inductive reasoning processes would be useful

in children with this profile, along with investigations of

executive/inhibitory control. Indeed, it may be possible that

the whole cognitive and behavioural pattern relies basically

to insufficient executive/inhibitory control which, besides its

involvement in self-regulation, play a central role in the

development of analogical reasoning,88,89 and cognitive

equilibration in general.90,91 This would be consistent with

the fact that attentional, working memory and executive

resources have been found lowered in referred gifted chil-

dren with a SVPD compared to intellectually homogeneous

ones.92

6.1. Limits

Some limitations have already been acknowledged; we

mention here additional ones which are shared by our three

studies.

The first one concerns definition of intellectual giftedness

on the single basis of IQ testing, which has intrinsic limits.93

Since IQ scores are defined through confidence intervals,

and may vary in a mean range of approximately 5% in gifted

children,94 categorization involves a small risk of error when

IQ score approaches the cut-off of 130. This bias is inherent to

categorization from a continuous variable which has a mea-

sure fluctuation, and its effect diminishes with statistical

power. More generally, it reflects the fact that clear-cut IQ

definition of giftedness entails a certain methodological

reductionism. Though this definition is the minimal and most

consensual one,1,2 it must also be mentioned that intellectual

giftedness has been conceptualized as involving additional

features, such as heightened emotional abilities and/or

Please cite this article in press as: Gu�enol�e F, et al., Wechsler prciations with trait-anxiety, emotional dysregulation, and heterogPaediatric Neurology (2015), http://dx.doi.org/10.1016/j.ejpn.2015

creative talent,95,96 and probably not all children in our

research would have corresponded to such multiple-trait

definitions of giftedness. This distinction between creative/

emotionally talented and atypical subtypes of high intelli-

gence should be investigated in future research.

We neithermade a distinction in our three studies between

SVPD in favour of Verbal or Performance IQ. Indeed, SVPD in

favour of Performance IQwas so infrequent that childrenwith

this pattern could not be regarded as distinct group in each of

our statistical comparison, which led us to pool both SVPD

patterns. Comparison between gifted childrenwith both SVPD

subtypes could thus be another interesting issue for future

research.

Since the three studies we report here were designed before

the publication of the fifth version of theDiagnostic and Statistical

Manual of Mental Disorders,97 clinical evaluation did not consid-

ered the new “Disruptive mood dysregulation disorder” cate-

gory,which is known to overlapwith emotional dysregulation.98

It is likely that anumber of childrenwouldhave corresponded to

thedefinition of this disorder, and thus not remained “nosologic

orphans”.42 Whatever, it is well-established that a significant

proportion of children with behavioural problems do not enter

current classifications of mental disorders,99,100 whereas they

display clear-cut dimensional psychopathology.25,101 This

particularly applies to children with emotional dysregulation,41

which justifies using dimensional models of childhood

psychopathology.25,100

Finally, since their distinction rests on cross-sectional

group comparison statistics, the two subtypes of gifted chil-

dren we described should be currently considered as pro-

totypes,101 which full characterization needs to be

investigated and confirmed longitudinally.

6.2. Conclusions

This research suggests that SVPD matters when considering

emotional and behavioural problems in gifted children, and

could be a risk indicator for psychopathology. This profile

could also matter for school teachers, when adapting

pedagogical support to the cognitive specificities of these

children.

More generally, our results support a clinical dichotomy of

behaviourally-impaired children with intellectual giftedness,

which precise definition and adapted therapeutic approaches

need to be investigated thoroughly, in a developmental

perspective and with long-term purposes.

Declaration of competing interest

The authors declare that they have no competing interests.

Role of the funding source

This research has been supported by a grant from the

Hospices Civils de Lyon (AO HCL e UF 31245), which had no

role in study design, analysis and interpretation of data,

writing of the report and decision of its submission for

publication.

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Acknowledgements

The authors thank Mr. Mathieu Griv�es, archivist at the

department of child and adolescent psychiatry of the Caen

University Hospital, for documentary search. They also thank

the anonymous reviewers, whose comments and suggestions

helped improving the manuscript.

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