Twice-exceptional and autism: how to cognitively stimulate children with dual exceptionalities

Iban Onandia-Hinchado, a psychologist specialized in child and adolescent neuropsychology, shares a practical guide on how to cognitively stimulate children with autism and high intellectual abilities.  

Introduction

Twice-exceptionality, known in English as twice-exceptionality (2e), refers to those children who simultaneously present high cognitive potential —high intellectual abilities (AACC)— and a neurodevelopmental disorder such as the autism spectrum disorder (ASD). This profile poses a challenge for educational systems, families and mental health professionals, as it combines extraordinary potential with specific needs that, if not addressed, can lead to frustration, anxiety and school failure (Assouline, Foley-Nicpon, & Doobay, 2010; Fernández-Alvarado & Onandia-Hinchado, 2022).

In this context, interest in the cognitive stimulation of children with twice-exceptionality is not merely academic: it is a social and educational necessity. School systems tend to address, on the one hand, children with ASD —through specialized support programs— and, on the other, children with AACC —with curricular enrichment measures—, but rarely integrate both approaches into a single plan. As a result, children with this profile are often underdiagnosed and poorly supported (Ronksley-Pavia, 2015).

This article explores the theoretical foundations of each condition, how twice-exceptionality manifests, its prevalence, diagnostic challenges, mental health risks and, especially, cognitive intervention strategies. It is based on key scientific articles as well as outreach materials from the Psicología Amorebieta blog, which provide applied and accessible examples.

What is autism and how does it influence children’s cognitive development?

ASD is a neurodevelopmental disorder defined by persistent impairments in reciprocal social communication and the presence of restrictive and repetitive patterns of behavior, interests or activities (APA, 2022). It represents great heterogeneity: some children show functional language and an intelligence quotient (IQ) within or above the average, while others have significant impairment of intellectual development and language. This variability requires speaking of a “spectrum”.

On the cognitive level, research such as Hill (2004) and Pellicano (2010) has shown that there are some strengths (visual and mechanical memory, attention to detail, logical-systematic reasoning, ability to detect patterns), but also challenges: deficits in executive functions (planning, flexibility, inhibition), difficulties in generalization, problems in theory of mind and social cognition.

A recent systematic review (Fernández-Alvarado & Onandia-Hinchado, 2022) confirms that the cognitive profile of ASD in child and adolescent populations is not reduced to a global deficit, but to a differential pattern with areas of strength and vulnerability, which has direct implications for educational and clinical intervention.

What are high intellectual abilities (AACC) and how do they manifest in childhood?

High intellectual abilities are a broad construct that encompasses children with cognitive performance significantly above average, whether in general intelligence (IQ > 130), in specific aptitudes (mathematics, language, musical, artistic) or in creativity and innovation (Subotnik, et al., 2011). 

Current models, such as Renzulli’s (2016), highlight three key components: intellectual ability, creativity and task commitment. In childhood, these translate into:

• Fast and deep learning.
• Insatiable curiosity and critical thinking.
• Ability to understand abstract concepts at early ages.
• Emotional and moral sensitivity, often accompanied by perfectionism.

However, not everything is advantageous: children with AACC can also experience frustration due to lack of challenge, feel different from their peers and develop anxiety or low self-esteem. 

Onandia-Hinchado (2025a) has worked on the idea that many behaviors interpreted as “hyperactivity” or “nervousness” hide, in some cases, a profile of high abilities that needs a different type of stimulation.

Autism and high intellectual abilities: how this twice-exceptionality manifests

The coexistence of ASD and AACC gives rise to heterogeneous profiles in which extraordinary talents combine with adaptive challenges. Restricted interests can become engines of talent, generating hyperspecialization in specific areas. However, the intellectual potential may be hidden by difficulties in organization, communication and cognitive flexibility (Foley-Nicpon, Assouline, & Colangelo, 2013). 

Moreover, when ASD and AACC coincide, a singular profile emerges:

• Restricted interests as talents: what is seen as obsession in autism, in combination with AACC can become an area of early specialization. Example: a child fascinated by planets who develops advanced skills in astronomy and mathematics.
• Mismatch between ability and performance: a student with high abstract reasoning may fail subjects due to lack of organization or social interaction problems.
• Heterogeneous cognition: they may excel on some WISC-V indices (perceptual reasoning, vocabulary), but score low in processing speed or working memory (Burger-Veltmeijer et al., 2011).

This contrast generates misunderstanding: teachers and families may see a “brilliant child” unable to integrate socially or to perform academically in a consistent way.

It has been emphasized how phenomena formerly described as a subtype of autistic disorder such as the savant syndrome show that talent can emerge in atypical profiles (Treffert, 2009).

Prevalence of the twice-exceptional profile: autism and AACC

Estimates of prevalence vary depending on methodology. Some studies suggest that between 2% and 10% of children with AACC also present ASD (Ronksley-Pavia, 2015). Conversely, around 5–7% of children with ASD would have an IQ above 120 (Baron-Cohen et al., 2009). The literature agrees that this is an underestimated and underdiagnosed profile. 

In Spain, the review by Fernández-Alvarado and Onandia-Hinchado (2022) highlights the absence of large population studies and the need for specific research.

Challenges and difficulties in diagnosing twice-exceptionality

Identifying this dual condition poses a challenge for several reasons:

1. Mutual masking: talent can hide the social difficulties typical of ASD, and communication problems can eclipse intellectual potential.
2. Limited instruments: tests like the WISC-V do not capture creativity or motivation, essential aspects of AACC.
3. Insufficient training: many teachers and counselors are not prepared to detect twice-exceptionality (Bianco et al., 2009).
4. Erroneous differential diagnoses: hyperactivity or lack of attention may be attributed solely to ADHD or to disruptive behavior.

The Psicología Amorebieta blog points out that hyperactivity or disruptive behaviors are often confused with other diagnoses, which underlines the importance of a differential approach (Onandia-Hinchado, 2025b).

Mental health in children with twice-exceptionality

These children present a higher risk of anxiety, depression and low self-esteem, derived from the mismatch between potential and performance, as well as experiences of social exclusion (Foley-Nicpon et al., 2013). Emotional and psychological support is as necessary as cognitive stimulation. Without it, the risks of exclusion and suffering increase. 

The Psicología Amorebieta blog devotes a space to the relevance of executive functions in psychological well-being, noting how they affect self-regulation and the ability to cope with complex demands (Onandia-Hinchado, 2025b).

How to intervene cognitively in children with autism and high intellectual abilities?

Effective interventions integrate enrichment strategies and supports typical of ASD in an integral and flexible way, combining strategies from gifted education with supports common in ASD. Among them are:

• Interest-based learning: Use restricted interests as a starting point for research projects, problem solving or creative activities.
• Curricular enrichment programs (Maker & Nielson, 1996), with exploration experiences, development of cognitive skills and in-depth projects.
• Training in executive functions and flexibility (Kenworthy et al., 2014), with planning activities (chess, robotics), flexibility (role-playing games, improvisation) and inhibition (attentional control dynamics).
• Promotion of divergent and creative thinking, through writing workshops, visual arts, open STEM challenges.
• Structured cooperative learning, where groups are organized with clear roles, positive interdependence and adult mediation.
• Use of technology and educational robotics, using adaptive platforms, programming apps (e.g., Scratch), robotics (e.g., Lego Mindstorms), etc. 
• Psychological support, where therapies for anxiety, low self-esteem or social skills are implemented.

The ideal program starts from a combination of all these measures, so that it adapts to the needs of the person undertaking it and allows objectives to be modified flexibly. Therefore, it involves carrying out a fully individualized intervention.

Conclusions and final recommendations

Children with high intellectual abilities (AACC) and autism spectrum disorder (ASD) represent a distinct profile within neurodiversity, where learning potential and creativity coexist with significant adaptive and socioemotional challenges. This twice-exceptionality is both an opportunity and a challenge for families, teachers and health professionals.

First, it is essential to break the invisibility. For too long, these profiles have remained hidden under partial diagnoses or low expectations, which has generated frustration, low self-esteem and loss of talent. Early identification, through protocols sensitive to both AACC and ASD, is the basis for any effective intervention.

Second, intervention programs must be flexible, individualized and multidisciplinary. It is not enough to apply standardized measures for ASD or AACC separately: it is necessary to design personalized pathways that integrate cognitive stimulation, educational supports and emotional accompaniment. The goal is not only to enhance academic performance, but also to foster autonomy, resilience and psychological well-being.

Third, a cultural and training change is required in the educational system. Teachers need resources, specific training and an open view of the diversity of profiles. Families, for their part, require guidance and support to understand that their child\’s characteristics are not a contradiction, but a unique way of developing their potential.

Fourth, it is essential to train teachers and families in understanding twice-exceptionality and to involve them actively in interventions. Awareness and training of the immediate environment are key elements for educational and clinical strategies to work. School and family should not be mere receivers of external guidelines, but co-responsible agents who participate in the planning, implementation and follow-up of measures. Only through this shared involvement can stable, coherent and enriching environments be generated that promote both the development of talent and socioemotional well-being.

Finally, it is essential to strengthen research. In Spain we hardly have solid population studies on the prevalence and evolution of this twice-exceptionality. Progress in this area will make it possible to design evidence-based educational policies and scientifically validated intervention programs.

In short, twice-exceptionality should not be understood as an obstacle, but as a horizon of possibilities. Properly attending to these children means not only promoting their personal development, but also enriching society with their unique talent. As Fernández-Alvarado and Onandia-Hinchado (2022) point out, the challenge is not to choose between enhancing talent or supporting needs, but to build an integral approach that combines both dimensions to guarantee inclusion, well-being and full development.

Bibliography

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“This article has been translated. Link to the original article in Spanish:”
Altas capacidades y autismo: cómo estimular cognitivamente a niños con doble excepcionalidad