Gifted students with coexisting disabilities, also known as twice-exceptional, are increasingly recognized in America’s schools. This increasing awareness needs to be met with equal enthusiasm for empirical investigation into the identification and treatment needs of this group of students. In this article, a 20-year review of the empirical literature examining twice-exceptionality, specifically gifted students with learning disabilities, attention deficit hyperactivity disorder, or autism spectrum disorder, was conducted. Research strongly suggests that gifted students can have a coexisting disability and that comprehensive, individualized approaches toward diagnosis are necessary. Less is known about effective treatments and interventions that simultaneously highlight strengths and accommodate for areas of growth. Future research directions are offered that ideally will encourage scholars to discover more about effective diagnostic and intervention techniques for this very important group of gifted learners. Putting the Research to Use The purpose of this article is to provide a comprehensive summary of the last 20 years of empirical research examining gifted students with specific learning disabilities, Attention-Deficit/Hyperactivity Disorder, or autism spectrum disorders. Scholars can extrapolate from this summary a research agenda that will move the field forward in the pursuit of empirically validated identification and intervention techniques with twice-exceptional learners. Educators are encouraged to use this information when developing gifted identification protocols in schools, accommodation plans for twice-exceptional students, and interventions that target specific strength and growth areas. Finally, parents of twice-exceptional learners can reference the empirical studies summarized as they search for research-based approaches to helping their child.

Greater use of spiritual resources, even if conceptualized as negative religious coping mechanisms or initial spiritual decline, may contribute to increased levels of spiritual growth later. When acting as expert companions, healthcare providers may facilitate spiritual growth by addressing spiritual transformation, creating safe environments for exploring spirituality, becoming familiar with different religious faiths, and seeking appropriate consultation and referrals for patients.

Many individuals seeking psychological services refer to their religious or spiritual beliefs during treatment (Shafranske and Maloney in Psychotherapy 27: 72-78, 1990). Although psychology has consistently pathologized religion and/or spirituality in the past, it is vital that clinicians understand their impact on diagnosis and treatment. The evolution of the DSM, as explored in this manuscript, is evidence of continued attempts to expand clinicians' religious and/or spiritual sensitivity. In order for religion to be incorporated as a cultural component, psychologists need appropriate training. The author concludes with a case illustration and recommendations for continued development of religion as a cultural factor in the DSM-V.

Awareness of one's own values, beliefs, and attitudes is one of the most important components of multicultural competence for psychotherapists (Sue & Sue, 2003). Several authors of the chapters in this volume stress the need for psychotherapists to understand how their own values interact and influence their abilities to provide psychotherapeutic services to clients. Two types of value conflicts can occur in the course of psychotherapy that can be difficult to resolve. First, conflicts can occur when clients encounter a clash between their spiritual beliefs and their personal issues and decisions. Often clients seek services from psychotherapists to help resolve these issues, but because psychotherapy is not a value neutral process, it is quite possible that psychotherapists themselves will encounter a second type of conflict when their own beliefs and values are different than those of their clients. In particular, value conflicts often occur when a psychotherapist's spiritual or religious beliefs clash with a client's presenting issue or course of action. Because most mental health training programs do not train students in how to deal with these conflicts, it can be difficult for psychotherapists to know how to resolve these issues, especially when there are strong feelings and beliefs involved.The purpose of the present chapter is to describe the types of value conflicts that may occur for clients and psychotherapists and to discuss ways in You have to start knowing yourself so well that you begin to know other people. A piece of us is in every person we can ever meet.-John D. McDonald (1974)

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