A genius with high goals, unmet

Q. A 13-year-old prodigy's intermittent symptoms of difficulty concentrating, tiredness, and "not accomplishing his goals in his studies" have grown more persistent over the past two months. (He knew the entire Bible by heart along with the cantillations by 8 years of age, and can tell you how often Abraham is mentioned in the Bible.) His family has not been able to help him reset the high intellectual goals he has set for himself to those that are more age-appropriate, and he remains lethargic. He spends much of his time with books, studying to be a Scribe.

He reports no insomnia, headache, abdominal pain, or other symptoms. He eats well, sleeps nine hours a night, gets 30 minutes of exercise three times a week, is social with other children, and is generally healthy. All routine blood tests and sleep lab are normal. He wears prescription glasses for distance.

The father also is a genius; the boy is home schooled, the oldest of six children in an intact, very supportive family. I detect no interfamily conflict. In addition to counterstimulation such as myofascial massage, do you have any other suggestions? (He was happy with my recommendation to see a psychologist.) Whereas this may be a transient situation, I would like to help him overcome his inability to meet the goals that are important to him.

A. The initial concern is whether these rather general symptoms are related to depression, difficulty adjusting to an unusual lifestyle, or a signal that his own expectations of sustained intellectual effort are unreasonable or unrealistic.

Typically, a 13-year-old hangs out, plays computer games, talks on the phone, or instant-messages. Neither genius nor exceptional artistic or athletic talent can substitute for, or short-circuit, a 13-year-old's developmental need for autonomy, peer relationships, and reasonable expectations to build self-esteem and identity. Anger or frustration that arises from family or personal expectations, an isolated home-schooled lifestyle, and insufficient peer contact and down time may contribute to an underlying problem that can not be remedied by increased intellectual effort.

To gain perspective on this child's situation we must acknowledge that we know very little about genius. The personal stories of prodigy and genius range from great success, to great frustration, to emotional disorder. We do know that feeling valued, loved, and cared for, together with having good friends, a sense of purpose, and sufficient resources, all support adolescent development, but do not lead to specific careers or degrees of productivity.

So, how do we evaluate nonspecific symptoms in a genius? I offer five lines of questioning that can serve as guidelines in this situation:

Parental expectation. What do the parents expect of their son? Are they sufficiently flexible and open to allow their child's goals, autonomy, and personality to emerge? Is there an unexpressed expectation that he follow in his genius father's footsteps? Do cultural or religious expectations reward him for his drive-or for his lethargy?

Intellectual ability. What are the child's intellectual strengths and weaknesses? A cognitive weakness-even in a genius-should not be ignored; in fact, a weakness can present an opportunity for the child to attend school with children of the same age, at least to study the problem subject or area. You could suggest a comprehensive battery of psychological tests to assess strengths, weaknesses, and personality.

History. A family or personal history of psychiatric problems may provide clues to the cause of the boy's current symptoms. Does his family or personal history suggest he is at risk for depression, anxiety, or obsessive-compulsive disorder?

Friends. Early adolescence is critical for extensive peer contact. Could this boy spend time in school-at least to participate in sports, art, lunch, or assemblies, or after-school activities such as the chess or debate club, or team sports? Could he attend summer camp, or another activity, with friends?

Fun. Is he getting enough down time? Every adolescent needs a fair measure of senseless fun.

Although this child's symptoms of lethargy and lamenting his lack of productivity may arise from emerging depression, they also may signal unmet adolescent needs. Given how little we understand of genius and the complexity of these circumstances, I would suggest you have several visits with this patient and his family using the five points noted above as a guideline for discussion.

Michael S. Jellinek, MD

DR. JELLINEK is professor of psychiatry and of pediatrics, Harvard Medical School, Boston; Chief, child psychiatry service, Massachusetts General Hospital, Boston; President, Newton Wellesley Hospital, Newton, Mass.