Parents are often told their child is “so smart, but…”
So smart, but struggles in school.
So smart, but disorganized.
So smart, but emotionally dysregulated.
For many families, this puzzling combination reflects twice exceptionality, commonly referred to as 2e. Twice-exceptional children have both high intellectual ability and a learning, attention, or emotional challenge. Because these children show remarkable strengths alongside real difficulties, they are often misunderstood, overlooked, or incorrectly labeled.
A twice exceptional (2e) child is a child who is intellectually gifted and has a co-occurring neurodevelopmental, learning, or emotional condition. Common co-occurring diagnoses include:
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• Learning disabilities (such as dyslexia, dysgraphia, or dyscalculia)
• Autism Spectrum Disorder
• Anxiety or mood disorders
Twice exceptional children often show a highly uneven profile of development.
Cognitive and personal strengths may include:
• Advanced vocabulary or verbal reasoning
• Exceptional creativity or imagination
• Strong problem-solving skills
• Intense curiosity or deep, focused interests
• Advanced understanding of complex topics
Areas of difficulty may include:
• Organization, planning, and time management
• Sustaining attention or regulating effort
• Written expression or academic output
• Emotional regulation or frustration tolerance
• Social communication or peer relationships
• Perfectionism or fear of failure
Why 2e Children Often Struggle in School
Despite high ability, many 2e children experience significant school-related challenges.
They may:
• Underachieve relative to their intellectual potential
• Appear inconsistent in performance
• Become easily frustrated or emotionally overwhelmed
• Avoid tasks that expose areas of weakness
Because of their intelligence, these children are sometimes perceived as lazy, unmotivated, or even oppositional. Over time, this misunderstanding can lead to anxiety, reduced self-confidence, and negative feelings about school.
How Neuropsychological Testing Helps Identify 2e Profiles
A comprehensive neuropsychological evaluation is necessary to identifying twice exceptionality.
Neuropsychological testing allows clinicians to:
• Assess intellectual strengths and reasoning abilities
• Identify subtle learning differences
• Evaluate attention and executive functioning
• Understand emotional and behavioral functioning
• Explain discrepancies between potential and performance
Rather than focusing on a single score, neuropsychological assessment examines the whole child, revealing how strengths and weaknesses interact in daily life.
Supporting Twice Exceptional Children
Support at School
Helpful strategies may include:
• Individualized Education Programs (IEPs) or 504 plans
• Accommodations for executive functioning challenges
• Explicit instruction in organization and planning
• Opportunities for advanced or enriched learning
• Flexible ways to demonstrate knowledge
Support at Home
At home, support should focus on:
• Validating both strengths and challenges
• Encouraging self-advocacy
• Reducing perfectionistic pressure
• Emphasizing growth and effort over output
• Helping children understand how their brain works
Twice exceptional children are not defined exclusively by their strengths or their struggles. They are defined by the interaction between the two. When giftedness and challenges are both recognized and supported, 2e children can thrive academically, socially, and emotionally. With the right understanding and strategies, these children can learn to embrace their unique profiles and reach their full potential.
Natalie Angelo, PsyD
Pediatric Neuropsychology Fellow