A sample of 2,409 intellectually talented adolescents (top 1%) who were assessed on the SAT by age 13 was tracked longitudinally for more than 25 years. Their creative accomplishments, with particular emphasis on literary achievement and scientific-technical innovation, were examined as a function of ability level (sum of math and verbal SAT scores) and tilt (math SAT score minus verbal SAT score). Results showed that distinct ability patterns uncovered by age 13 portend contrasting forms of creative expression by middle age. Whereas ability level contributes significantly to creative accomplishments, ability tilt is critical for predicting the specific domain in which they occur (e.g., securing a tenure-track position in the humanities vs. science, technology, engineering, or mathematics; publishing a novel vs. securing a patent).