Twice Exceptional ADHD and Twice Exceptional Autism Testing

We specialize in twice exceptional ADHD and 2e Autism evaluations—comprehensive, strength-based assessments for individuals who are both gifted (high IQ) and have neurodevelopmental differences. 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 the twice exceptional autism and 2e ADHD assessment 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

High IQ 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 2e 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 Twice Exceptional ADHD Evaluation Process

Our twice exceptional 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 (2e 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:

• 2e 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.

Twice Exceptional ADHD Testing Case Examples

The following examples show how we perform twice exceptional ADHD testing in our practice.

Twice Exceptional ADHD Testing: “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.

Twice Exceptional ADHD 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.

Twice Exceptional ADHD Testing Interpretation:

Eli’s profile reflected 2e ADHD – Combined Presentation. His strong reasoning was undermined by inconsistent attention and working memory lapses.

2e ADHD Recommendations:

• School: Academic accommodations including extended time, organizational scaffolding, option to verbalize complex ideas instead of written summaries.
• Clinical: CBT for ADHD-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.

Twice Exceptional ADHD Testing: “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.

Twice Exceptional ADHD Assessment 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.

Twice Exceptional ADHD Assessment Interpretation:

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

2e ADHD 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 and 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 2e Autism testing.

Why 2e Autism is Often Missed

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 dysregulation. Others are misdiagnosed with ADHD, anxiety, or mood disorders. A 2e 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 Twice Exceptional Autism 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

Twice Exceptional Autism Assessments often lead to three categories of recommendations:

Clinical:

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

Holistic:

• Mind-body regulation: deep breathing, use of a weighted blanket, 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.

Twice Exceptional Autism Testing Case Studies

The following case studies illustrate how we conduct twice exceptional autism assessments in our practice.

Twice Exceptional Autism Testing: “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.

Twice Exceptional Autism 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.

Twice Exceptional Autism Testing Interpretation:

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

2e Autism 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 that she began initiating group discussions, especially when the topic was related to her interests.

Twice Exceptional Autism Testing: “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.”

Twice Exceptional Autism Assessment 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.

Twice Exceptional Autism Assessment 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.

2e Autism Recommendations:

• Clinical: Psychoeducation and psychotherapy focused on social energy budgeting and identity acceptance.
• Workplace: Flexible scheduling, quiet workspace, and 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 Gifted ADHD and Twice Gifted Autism Testing: Adults vs. Children

Understanding Developmental Differences Across the Lifespan

While the principles of twice gifted ADHD and Autism 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 twice gifted autism or ADHD assessment is developmentally appropriate and personally meaningful.

1. Twice Gifted ADHD and 2e Autism Testing: Purpose and Goals

Twice Gifted ADHD and 2e Autism Evaluations for Children and Adolescents:

• The primary purpose of a twice gifted ADHD or Autism assessment is to inform education and support systems.
• Twice gifted Autism or ADHD testing clarifies learning profiles, guides school accommodations (IEPs, 504 Plans), and helps teachers understand how to nurture strengths while supporting weaknesses.
• It also supports early self-understanding, helping the child or teen build a positive identity around their abilities and challenges before frustration or low self-esteem sets in.

Twice Gifted Autism and 2e ADHD Evaluations for Adults:

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

2. Nature of the Referral Questions

3. Twice Gifted ADHD and 2e Autism Testing Approach

There are differences in how we prepare assessments depending on the client’s age:

Twice gifted ADHD and 2e Autism Assessments 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 the school setting, peer relationships, and family dynamics.
• Play-based or interest-based engagement helps children feel comfortable and show authentic ability.

Twice gifted Autism and 2e ADHD Assessments 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 greater emphasis on identity development, emotional resilience, and coping strategies than on academic remediation.

4. Recommendations and Follow-Through

Twice gifted Autism and 2e ADHD Assessments 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.

Twice gifted ADHD and 2e Autism Assessments For Adults:

• Twice gifted ADHD or Autism testing 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 twice gifted ADHD or Autism assessment 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 minds are unique assets worth celebrating.

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

6. Twice Exceptional ADHD and Autism Shared Values Across Ages

Despite these differences, all twice gifted ADHD and Autism Assessments share common goals:

• Provide clarity and validation.
• Celebrate both giftedness and neurodiversity.
• Foster practical pathways toward thriving—in learning, work, and relationships.
• Help individuals embrace their profiles as complex but powerful systems, rather than flaws to fix.

Twice Gifted Autism and ADHD Testing: Adult vs. Child Key Differences

Twice Exceptional ADHD and Autism: An Integrative Perspective

Ultimately, twice gifted autism or ADHD 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 of each twice gifted autism or ADHD assessment is empowerment: helping gifted, neurodivergent individuals understand themselves deeply and create environments where they can flourish intellectually, emotionally, and socially.

Conclusion and Our Work

2e ADHD 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 are empowering rather than limiting.

Twice Exceptional ADHD and Autism Testing Services

Understanding Gifted Minds with Complex Needs

Whether 2e ADHD, 2e autism, or both, our holistic approach fosters self-understanding, resilience, and direction. 2e individuals don’t need to “fit in”—they need environments that fit them. We provide twice gifted Autism and ADHD testing for all ages, and twice exceptional testing for other combinations, and we welcome you to contact us or schedule a consultation anytime.

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