Gifted, Twice Exceptional, and Anxious: Understanding the Inner World of High‑Masking Children
As a play therapist in Littleton, Colorado, I often meet with children who are bright, insightful, deeply sensitive, and outwardly “doing fine” — yet internally overwhelmed. These are the children who mask well. They may earn strong grades, speak articulately, and meet adult expectations, while privately carrying anxiety, self‑doubt, sensory overload, or emotional exhaustion.
Many of these children fall under the umbrella of giftedness or twice exceptionality (2e). Understanding these profiles can be profoundly validating for families and can open the door to more attuned mental health support.
What Does It Mean to Be a Gifted Child?
Giftedness is not an official diagnosis in the DSM-5, but a neurodevelopmental profile characterized by advanced cognitive abilities in one or more areas such as reasoning, problem‑solving, verbal skills, or creativity. Researchers and organizations such as the National Association for Gifted Children emphasize that giftedness involves qualitative differences in how children think, feel, and perceive the world — not simply being “good at school.”
Importantly, gifted children often show asynchronous development: Their intellectual abilities may be years ahead of their emotional regulation, social skills, or executive functioning. A child may be able to reason about complex moral or existential topics while still having very age‑typical emotional meltdowns.
This developmental mismatch can create internal tension and vulnerability, particularly in environments that assume cognitive maturity equals emotional readiness.
What Is Twice Exceptionality (2e)?
Twice exceptional children are both gifted and neurodivergent. This may include autism, ADHD, learning disabilities (such as dyslexia or dysgraphia), sensory processing differences, or executive functioning challenges.
One of the most challenging aspects of 2e profiles is mutual masking:
Giftedness can compensate for areas of difficulty, delaying identification of neurodivergence.
Neurodivergent challenges can obscure gifted potential, leading to underestimation of ability.
Researchers consistently note that 2e children are among the most under‑identified and misunderstood populations in both educational and mental health systems.
Masking: When Strengths Hide Struggles
Many gifted and 2e children become highly skilled at masking. They quickly learn what is expected and work hard to meet those expectations, even if this comes at a high internal cost.
Masking may look like:
Intense effort to appear calm, compliant, or “easy” at school
Suppressing sensory discomfort or emotional reactions
Over‑reliance on intellectualization
Exhaustion, irritability, or emotional collapse at home
For neurodivergent children in particular, chronic masking has been linked in research to increased anxiety, burnout, and identity confusion over time.
Sensitivity, Intensity, and Overexcitability
Many gifted children experience the world with notable intensity. Psychiatrist Kazimierz Dabrowski describes this as overexcitability — heightened responsiveness in emotional, sensory, intellectual, imaginational, or psychomotor domains.
These children may:
Feel emotions deeply and empathetically
Be highly sensitive to noise, textures, or transitions
Think constantly and ask complex questions
Experience vivid imagination or strong inner narratives
While these traits can be strengths, they also increase susceptibility to overwhelm and anxiety, particularly in fast‑paced or overstimulating environments.
Common Mental Health Challenges in Gifted and Twice Exceptional (2e) Children
Anxiety
Anxiety is one of the most common reasons gifted and 2e children are referred to therapy. Their anxiety may include:
Perfectionism and fear of making mistakes
Anticipatory worry and rumination
Existential concerns (such as worries about death, injustice, climate, global events) that don’t always match a child’s development
Heightened awareness of others’ emotions or expectations
Researchers note that anxiety in gifted children is often cognitively complex and may not present in traditional ways.
Perfectionism and Self‑Criticism
Early academic success can unintentionally teach gifted children that worth is tied to performance. When tasks become difficult — as they inevitably do — these children may respond with intense self‑criticism, avoidance, or emotional shutdown.
Maladaptive perfectionism has been linked to anxiety, depression, and reduced resilience in gifted populations. Over time, this can lead to avoidance of challenges or anything they aren’t immediately good at.
Emotional Dysregulation
Despite advanced reasoning skills, many gifted and 2e children struggle with emotional regulation, especially if they’re highly sensitive and experience emotional intensity. When expectations exceed regulatory capacity, distress may emerge as:
Meltdowns after long periods of coping
Somatic complaints
Irritability or rigidity
This is often misinterpreted as oppositional behavior rather than a stress response.
Social Disconnection
Gifted and 2e children frequently report difficulty finding true peers — children who share similar interests, communication styles, or depth of thinking. This can lead to loneliness, masking in social settings, or a preference for adults or solitary play.
Why a Neurodiversity‑Affirming Lens Matters
When gifted and twice exceptional children are understood only through behavior or performance, their internal experience is often missed. A neurodiversity‑affirming, strengths‑based approach emphasizes:
Validation of sensitivity and intensity
Support for emotional regulation and self‑understanding
Reducing shame around differences
Building resilience without minimizing distress
Play therapy, in particular, offers a developmentally appropriate way for these children to express what may be difficult to articulate verbally. With proper support, children can learn how to regulate their emotions, build resiliency and self-compassion, and better understand their sensory needs so they no longer feel pressure to mask throughout the day before collapsing at home.
Final Thoughts
Gifted and twice exceptional children are not simply “more capable versions” of typical development. They are children with unique nervous systems, complex inner worlds, and real mental health needs.
When we slow down, look beneath the mask, and meet them with curiosity and attunement, we give them the message they most need to hear:
You don’t have to hide to survive. You’re allowed to show up authentically.
If you’re looking for mental health support from a neurodiversity-affirming provider who understands your child’s unique brain and nervous system needs, click the button below to schedule a free 15-minute introduction call.