"All that glitters is not gold" ... a well known axiom which, for the gifted child, is perhaps better phrased as "All that is gold does not glitter." There are numerous significant variables which may compromise the potentials of gifted children; for example, the gifted child with a learning disability. Indeed, there is a need to demystify the popular myths which tend to place the gifted child in jeopardy, such as: "all gifted children succeed in all academic subjects without special concerns; all gifted children eventually do well academically and, therefore, financially"... and a demeaning belief that "gifted children walk a thin line between being a ‘genius’ and severely disturbed emotionally."

S. Marland, Jr., in the 1972 definition of "gifted and talented" (Education of the Gifted and Talented, Report to the Congress of the United States by the U.S. Commissioner of Education) suggested that:

Gifted and talented children are those identified by professionally qualified persons who, by virtue of outstanding abilities, are capable of high performance. These are children who require differentiated educational programs in order to realize their contribution to self and society. Children capable of high performance include those with demonstrated achievement and/or potential ability in any of the following areas, singly or in combination:

1. General intellectual ability
   
2. Specific academic aptitude
   
3. Creative or productive thinking
   
4. Visual and performing arts
   
5. Psychomotor ability

The healthcare provider is ‘pleasantly’ challenged by the gifted preschooler, who usually presents with "interesting" characteristics:

• uses advanced vocabulary for age
  
• may read at an early age (and maybe self-taught)
  
• assembles puzzles designed for older children
  
• has a sense of humor
  
• demonstrates an understanding of abstract concepts
  
• quickly learns to master new skills
  
• physically, may develop skills at an early age
  
• develops a sense of empathy
  
• good attention span
  
• frequently asks "why-what-where-and when" questions

As time progresses, and some degree of consideration is provided for the child’s potentials, evidences of giftedness surface:

General Intellectual Ability: Formulates abstractions, processes information in complex ways, is observant and excited by new ideas, uses a large vocabulary, is inquisitive, learns rapidly.

Creative Thinking: An independent thinker, original thinking in oral and written expression, creates and invents, improvises, offers several solutions to a problem.

Specific Academic Ability: Excellent memory, advanced comprehension, widely read, high academic achievement (in areas of special interest), pursues interests with enthusiasm, learns quickly

Psychomotor Development: Challenged by athletic activities, good precision movements, outstanding in motor skills, very well coordinated, high energy level.

Visual Performing Arts: Excellent skills in spatial relationships, outstanding in expressing self, creative expression, observant, desires to create on own, good motor skills.

Leadership: Assumes responsibilities, fluent and concise, good insights, good judgment in making decisions, organized, self-confident, admired and liked by peers.

All or some of these characteristics may surface as suggesting "gifted" potential in various areas.
The educational models for gifted children, for the most part, traditionally utilized four program designs: (1) ability grouping; (2) acceleration; (3) enrichment; and (4) "do nothing." Of the choices made available, enrichment appears to provide the best approach, in that the children are not separated from their heterogeneous peer group, and the program is less expensive than ability grouping. The downside focuses on a program which is utilized in a traditional classroom in which the teachers may not be specially trained to work with gifted children; resulting in poor program design and coordination.

It is important to recognize that gifted children are as vulnerable as non-gifted children to a variety of physical, psychological, educational, and psychosocial stresses. Indeed, in many instances, these vulnerabilities are exaggerated in the life experience of gifted children. Once identified as "gifted," is the child expected to make all As on his/her report card? give up all the recreational and emotional joys of his/her age-appropriate development? and to devote all energies and peer associations to satisfy an IQ score? The definition proposed by Marland (1972) did not recommend nurturing a gifted child at the expense of raising a normal child!

Inasmuch as much of the focus on the gifted child relates to academic accomplishments, it is necessary to note that Daniels (1983) defined four groups of gifted children:

1. Gifted Achievers: Gifted with no learning, reading or language disability.

2. Gifted Non-Achievers: Gifted with no learning, reading or language disability, but not performing at their potential academic level.

3. Gifted Pseudo-Achievers: Gifted with a learning disability, but functioning at grade level.

4. Gifted/Learnning-Disabled: Gifted with a learning disability, but not succeeding either at grade level or level of academic potential.

The potential "bottom line" for the gifted/learning disabled/academic underachiever maybe a self-perpetuating cycle of psychoeducational, emotional and social disasters:

• Academic Underachiever
  
• Gifted but Poor Self-Concept
  
• Learning Disabled Emotional Sequelae
  
• Compromised Adult Productivity

There is a defined role for primary healthcare providers in management of gifted children and adolescents. The major concerns are: enhance the child’s self-concept and interrupt the cycle which may compromise a productive life as an adult. The physician’s responsibility in stabilizing family dynamics, decreasing educational confusions and providing direct patient interventions cannot be ignored. Gifted children and adolescents do not necessarily adhere to the axiom that "all that is gold, glitters" ... primary healthcare providers may play a catalyst role in insuring that gifted children do shine!