Twice Exceptional ADHD and Twice Exceptional Autism Testing

We specialize in twice-exceptional (2e) evaluations—comprehensive, strength-based assessments for individuals who are both gifted and have neurodevelopmental differences such as ADHD or Autism Spectrum Disorder. These individuals often show remarkable reasoning, creativity, or memory yet struggle with organization, attention, or social understanding.

Our mission is to uncover the whole picture: the intellectual strengths that fuel curiosity and the challenges that interfere with consistency. Through this process, we help individuals and families gain clarity, validation, and practical guidance for growth. We integrate clinical psychology, neuropsychology, educational testing, and functional life assessment—allowing for nuanced insights that support both performance and well-being.

Twice Exceptional ADHD Testing

The following is a general overview of the twice-exceptional ADHD testing we provide.

Why It’s Helpful

Gifted individuals with ADHD are often misunderstood. A child might appear lazy or oppositional when they are actually overwhelmed by their own fast-thinking, distractible mind. Adults may compensate for years before burnout or chronic stress emerges. A twice-exceptional ADHD evaluation can:

• Identify how attention and executive weaknesses intersect with gifted abilities.
• Differentiate ADHD from overexcitabilities, perfectionism, or asynchronous development.
• Provide tailored supports—academic, occupational, emotional, and behavioral.
• Offer concrete guidance for coaching, therapy, and self-management strategies.

The Evaluation Process

Our ADHD testing process includes a comprehensive and personalized diagnostic evaluation, including:

1. Clinical Interview and Background Review
   • Developmental, educational, and family history.
   • Review of previous test data, report cards, and teacher observations.
   • Exploration of sleep, nutrition, and stress factors that affect attention.
2. Behavioral and Executive Function Rating Scales
   • Conners 4, BRIEF-2, CAARS, and BASC-3 (child or adult versions).
   • Collateral input from parents, teachers, or partners.
3. Cognitive Testing
   • WISC-V or WAIS-IV to assess verbal reasoning, perceptual reasoning, working memory, and processing speed.
   • Analysis of intra-individual variability (how peaks and troughs reveal ADHD-related inefficiency).
4. Attention and Executive Function Measures
   • CPT-3 or TOVA (computerized attention tasks measuring omission and commission errors).
   • Trail Making Test, Stroop Color-Word, D-KEFS Tower or Sorting Test for planning and flexibility.
5. Academic Efficiency Testing
   • WIAT-4 subtests for written expression, math fluency, and reading speed to detect underperformance relative to ability.
6. Emotional and Personality Assessment
   • PAI, MMPI-A-RF, or Beck Inventories to understand mood, stress, and self-regulation patterns.
7. Feedback and Recommendations Session
   • Integrates data with lived experience.
   • Develops a detailed plan emphasizing both remediation and strength-based development.

Common Outcomes and Recommendations

Clinical:

• Diagnostic clarification (ADHD subtype, comorbid anxiety, or learning differences).
• Discussion of evidence-based treatments, including possible stimulant or non-stimulant medications, CBT, or executive functioning therapy.

Holistic:

• Sleep hygiene interventions, mindfulness, and movement-based self-regulation (e.g., yoga, tai chi, aerobic activity).
• Nutrition guidance (omega-3s, blood sugar regulation, hydration).
• Incorporation of creative and sensory outlets that enhance focus (art, music, nature exposure).

Self-Help and Coaching:

• ADHD coaching for planning, initiation, and task management.
• Use of technology aids (structured digital planners, time-blocking, focus apps).
• Skill-building in self-compassion, frustration tolerance, and resilience training.

Case Study: Child – “Eli” (Age 11)

Eli was a curious, humorous 11-year-old who excelled in robotics and science but frequently lost materials and failed to complete classwork. Teachers described him as “brilliant but scattered.” Parents noted daily struggles with transitions and emotion regulation.

Testing Results:

• WISC-V: Very Superior Verbal Comprehension (score 140), but Working Memory at 95 and Processing Speed at 90—indicating cognitive inefficiency despite high reasoning.
• CPT-3: Elevated omission errors (poor sustained attention).
• BRIEF-2: Clinically elevated Initiate, Working Memory, and Emotional Control scales.
• BASC-3: Internalizing symptoms consistent with frustration and self-doubt.

Interpretation:

Eli’s profile reflected ADHD – Combined Presentation within a gifted learner. His strong reasoning was undermined by inconsistent attention and working memory lapses.

Recommendations:

• School: Extended time, organizational scaffolding, option to verbalize complex ideas instead of written summaries.
• Clinical: CBT-based skills training and family sessions to reduce conflict around schoolwork.
• Holistic: Outdoor activity before homework, mindfulness breathing before transitions, and structured creative outlets (robotics, drawing).
• Self-Help: Visual checklists, reward charts focused on effort, and a “strength journal” to build self-esteem.

Outcome:

Six months later, Eli was completing more assignments independently and proudly presented a robotics project at a science fair. Teachers reported improved persistence and emotional maturity.

Case Study: Adult – “Sara” (Age 36)

Sara, an engineer, described herself as “brilliant at starting but terrible at finishing.” She had a history of academic success but increasing burnout at work.

Testing Results:

• WAIS-IV: Verbal Comprehension 132, Working Memory 102, Processing Speed 88.
• TOVA: Variable response times and frequent commission errors.
• CAARS: Clinically significant inattentive and disorganized subscales.
• PAI: Mild anxiety and perfectionism, but intact self-concept.

Interpretation:

Sara’s results supported ADHD – Predominantly Inattentive Type with perfectionism-related anxiety. Her gifted verbal reasoning masked disorganization until professional demands grew.

Recommendations:

• Clinical: Trial of stimulant medication with medical provider; CBT for perfectionism and productivity stress.
• Holistic: Structured work breaks, ergonomic workspace, regular aerobic exercise.
• Self-Help: Pomodoro time-blocking, visual Kanban board, journaling about “wins,” and engaging in creative hobbies to sustain motivation.

Outcome:

With coaching and improved routines, Sara’s work efficiency increased, and she regained her sense of competence. She later mentored younger engineers on managing workload and focus.

Twice-Exceptional Autism Testing

Here is a general overview of twice-exceptional ADHD testing.

Why It’s Helpful

Gifted individuals on the autism spectrum often fly under the radar. Their advanced intellect and vocabulary can mask difficulties with social reciprocity, sensory sensitivities, and emotional regulation. Others are misdiagnosed with ADHD, anxiety, or mood disorders. A twice-exceptional autism evaluation can:

• Distinguish between gifted intensity and autistic social-cognitive differences.
• Identify sensory, communication, and flexibility challenges that impede functioning.
• Guide educational and occupational environments to support both intellect and comfort.

The Evaluation Process

1. Comprehensive Interview exploring developmental history, social functioning, sensory preferences, and adaptive behavior.
2. Cognitive Assessment: WISC-V / WAIS-IV with emphasis on visual-spatial reasoning, processing style, and pattern detection.
3. Autism-Specific Instruments:
   • ADOS-2 (gold standard structured observation).
   • MIGDAS-2 (conversation-based diagnostic guide).
   • SRS-2 and SCQ (social responsiveness and communication rating scales).
4. Executive Functioning and Emotional Regulation Testing: NEPSY-II, D-KEFS, and BRIEF-2.
5. Adaptive Functioning: Vineland-3 or ABAS-3 to assess practical life skills.
6. Social Perception Measures: Facial emotion recognition, theory of mind tasks, and pragmatic language observations.

Outcomes and Recommendations

Clinical:

• Diagnostic clarification and guidance on evidence-based interventions (CBT for anxiety, social learning therapy, occupational therapy for sensory issues).
• Psychoeducation for family or workplace about autism as a difference, not deficit.

Holistic:

• Mind-body regulation: deep breathing, weighted blanket use, gentle stretching, or quiet spaces for decompression.
• Nutrition and sleep rhythm optimization to reduce sensory reactivity.
• Encouragement of creative interests (coding, art, writing, music) as emotional outlets.

Self-Help:

• Structured routines with visual supports and time anchors.
• Peer mentoring or interest-based social groups.
• Online communities and reading materials on neurodiversity and self-advocacy.

Case Study: Child – “Lena” (Age 9)

Lena was a precocious reader with a fascination for astronomy and advanced vocabulary. Teachers admired her intellect but worried about her social withdrawal and meltdowns during noisy group activities.

Testing Results:

• WISC-V: Verbal Comprehension 138, Visual Spatial 126, Processing Speed 88.
• ADOS-2: Subthreshold repetitive behaviors, but significant differences in reciprocity and eye contact.
• SRS-2: Elevated T-scores in Social Awareness and Social Communication.
• Vineland-3: Adaptive functioning within average range but low Socialization subscale.

Interpretation:

Findings indicated Autism Spectrum Disorder, Level 1, within a gifted cognitive profile. Her perfectionism and sensory overload mimicked anxiety but stemmed from autistic processing differences.

Recommendations:

• Clinical: Individual therapy integrating CBT and mindfulness to build emotional flexibility.
• Educational: Quiet testing space, sensory breaks, and participation in advanced science activities.
• Holistic: Deep-pressure play (weighted blanket, yoga), nature walks, and reduced after-school overload.
• Self-Help: A “social success journal” for reflecting on positive peer interactions.

Outcome:

Within a year, Lena was more self-aware and confident. Teachers reported she began initiating group discussions, especially when related to her interests.

Case Study: Adult – “Miguel” (Age 29)

Miguel, a talented graphic designer, described lifelong feelings of social exhaustion and difficulty adapting to change. He had never been tested, assuming he was “just introverted.”

Testing Results:

• WAIS-IV: Visual-Spatial 135, Verbal Comprehension 120, Processing Speed 85.
• ADOS-2: Subtle social reciprocity challenges, concrete communication style.
• SRS-2: T-score 78 (clinically significant).
• ABAS-3: Adaptive skills average, but low flexibility and time management.

Interpretation:

Results confirmed Autism Spectrum Disorder, Level 1, with superior visual and creative strengths. His differences in sensory processing and conversational style accounted for his social fatigue.

Recommendations:

• Clinical: Psychoeducation and therapy focused on social energy budgeting and identity acceptance.
• Workplace: Flexible scheduling, quiet workspace, written instructions over verbal.
• Holistic: Grounding techniques before presentations, structured downtime after intense projects.
• Self-Help: Autistic self-advocacy groups, sensory-friendly headphones, and journaling about design ideas as emotional regulation.

Outcome:

Miguel reported feeling “finally understood.” He negotiated a modified work environment and started mentoring other neurodivergent creatives.

Twice-Exceptional Testing: Adults vs. Children

Understanding Developmental Differences Across the Lifespan

While the principles of twice-exceptional (2e) evaluation remain consistent—identifying the coexistence of high ability and neurodevelopmental differences—the process, focus, and goals of testing differ significantly between adults and children. Recognizing these distinctions ensures that each assessment is developmentally appropriate and personally meaningful.

1. Purpose and Goals

For Children and Adolescents:

• The primary purpose is to inform education and support systems.
• Testing clarifies learning profiles, guides school accommodations (IEPs, 504 Plans), and helps teachers understand how to nurture strengths while supporting weaknesses.
• It also aids early self-understanding—helping the child or teen build a positive identity around their abilities and challenges before frustration or low self-esteem develops.

For Adults:

• The focus shifts to self-understanding, occupational functioning, and life management.
• Adults often pursue testing after years of mixed success—strong intellectual or creative achievement alongside chronic stress, burnout, or interpersonal difficulties.
• Evaluation provides clarity for career alignment, workplace accommodations, coaching, therapy planning, and sometimes late-in-life self-acceptance (“Now it all makes sense”).

2. Nature of the Referral Questions

3. Assessment Approach

For Children:

• Emphasis on developmental history, parental and teacher input, and observation of learning style.
• Tools often include:
  • WISC-V, WIAT-4, ADOS-2, BRIEF-2, Conners 4, BASC-3, and Vineland-3.
• The evaluator considers school setting, peer relationships, and family dynamics.
• Play-based or interest-based engagement helps children feel comfortable and show authentic ability.

For Adults:

• The process relies on self-report, life narrative, and functional history rather than third-party observers.
• Measures might include:
  • WAIS-IV, CAARS, ASRS, TOVA, SRS-2 Adult, PAI, MMPI-3, D-KEFS, and detailed qualitative interviews.
• Adults benefit from a collaborative, insight-oriented process that connects test findings to lived experience.
• There is often a greater focus on identity development, emotional resilience, and coping strategies rather than academic remediation.

4. Recommendations and Follow-Through

For Children:

• Recommendations focus on school accommodations, behavioral supports, and family-based interventions:
  • Enrichment programs or gifted pull-outs.
  • Executive function scaffolding and teacher training.
  • Emotional regulation strategies integrated into classroom life.
  • Parent coaching to encourage independence while reducing conflict.

For Adults:

• Recommendations target self-management, relationships, and work-life balance:
  • Career coaching focused on strength alignment and energy regulation.
  • Mental health therapy (CBT, ACT, or schema-focused) for perfectionism, rejection sensitivity, or self-doubt.
  • Executive function coaching and environmental design (routines, technology aids).
  • Holistic self-care—exercise, mindfulness, diet, sensory regulation, and creativity as balance.

5. Emotional and Identity Impact

In Childhood:
Early identification can transform self-esteem. A 2e evaluation reframes the narrative from “lazy” or “oppositional” to “bright but wired differently.” Children begin to understand that their challenges have an explanation—and that their mind is a unique asset worth celebrating.

In Adulthood:
Adults often experience profound relief after years of feeling “different” or “not living up to potential.” A 2e evaluation provides closure and self-compassion, validating both achievement and struggle. For many, this insight allows authentic living—choosing careers, relationships, and environments that fit their true neurotype.

6. Shared Values Across Ages

Despite these differences, all 2e testing shares common goals:

• To provide clarity and validation.
• To celebrate both giftedness and neurodiversity.
• To foster practical pathways toward thriving—in learning, work, and relationships.
• To help individuals embrace their profiles as complex but powerful systems, rather than flaws to fix.

Summary Table: Key Differences

Integrative Perspective

Ultimately, twice-exceptional assessment is a lifespan process. A child who receives supportive testing early may grow into an adult with insight and self-advocacy skills. An adult discovering their 2e profile later in life can still experience immense transformation—understanding that past struggles were not moral failings but reflections of an extraordinary mind operating differently.

In both cases, the goal is empowerment: helping gifted, neurodivergent individuals understand themselves deeply and create environments where they can flourish intellectually, emotionally, and socially.

Conclusion and Our Work

Twice-exceptional testing celebrates the coexistence of high potential and real challenges. By integrating cognitive science with empathy, we help individuals discover their full profiles—so that interventions become empowering, not limiting.

Understanding Gifted Minds with Complex Needs

Whether the concern is ADHD, autism, or both, our holistic approach fosters self-understanding, resilience, and direction.
Twice-exceptional individuals don’t need to “fit in”—they need environments that fit them.

Dr. Alan Jacobson, Psy.D., MBA Founder and President

Dr. Jacobson is a senior-level licensed clinical psychologist who has been practicing for over 20 years. He founded the Virtual Psychological Testing Group in 2021. He provides psychological and neuropsychological testing for adolescents and adults.

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Psychology Psychological testing Neuropsychological testing