MULTIPLE EXCEPTIONALITY IN CHILDHOOD AND ADOLESCENCE: A CRITICAL SYNTHESIS OF MULTIMODAL INTERVENTIONS AND DIAGNOSTIC CHALLENGES AT THE INTERSECTION OF GIFTEDNESS, AUTISM SPECTRUM DISORDER, AND BIPOLAR DISORDER

Abstract

Multiple exceptionality, understood as the coexistence of high intellectual abilities, autism spectrum disorder (ASD), and/or bipolar disorder, constitutes a highly complex clinical and educational phenomenon, characterized by heterogeneous profiles of strengths and needs. This article synthesizes the scientific evidence on interventions for this population, based on the analysis of relevant studies. The findings show an incipient but promising development in interventions targeting dual combinations, particularly ASD with bipolar disorder and high abilities with ASD, while evidence on the triple combination is practically nonexistent.

Pharmacological interventions, especially second-generation antipsychotics and lithium, show comparable efficacy in young people with ASD-bipolar disorder comorbidity, although with greater initial functional impairment. On the other hand, psychoeducational, behavioral, and cognitive-behavioral interventions show consistent results in improving emotional regulation, social skills, and adaptive functioning, especially when tailored to individual characteristics.

Significant diagnostic barriers are identified, such as overlapping symptoms and masking between conditions, which hinder early detection and the design of appropriate interventions. Furthermore, significant gaps in the literature are observed, including a scarcity of longitudinal studies, controlled trials, and models specifically designed for complex multiple exceptionality.

It is concluded that it is essential to move toward multimodal, individualized, and strengths- based approaches, as well as to strengthen specialized training and interdisciplinary research to improve the clinical and educational outcomes for this population.