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Giftedness and ADHD

Giftedness and ADHD

Giftedness is (actually) a technical term and refers to people with an IQ of 130 or higher (2.1 to 2.28% of all people). An IQ of 140 and higher occurs in 0.7% of all people, an IQ of 145 and higher in 0.1%.
However, this article does not use the narrow definition of giftedness, but generally refers to people with an IQ that is significantly above the average of 100.

A significantly reduced intelligence is associated with an increased risk of ADHD. This applies not only to an IQ of less than 70, but also to an IQ of 70 to 85.1

Even though we know many gifted people who suffer from ADHD, our following presentation is not intended to equate ADHD and giftedness, nor to justify one with the other. However, in dealing with the topics of ADHD, giftedness and high sensitivity (according to Aron) or heightened sensitivity, we have come across so many parallels and points of contact that we could not help but ask ourselves whether these could be helpful in the search for an explanation of ADHD.

1. ADHD more common with giftedness?

A number of sources claim that ADHD sufferers have a lower2 or no higher IQ than non-affected people.3 Some report a slightly below-average to normally distributed intelligence with 10% of sufferers having an IQ of 1204, others report 5 to 6% of ADHD sufferers5 in the verbal IQ range, which would be significantly above average.

A more recent study shows a massively above-average incidence of ADHD symptoms in adults with an IQ of 130 and above (37%) and in 7.7% of children with an IQ of 135 and above, which is almost three times more frequent than in the control group (2.8%).6 In 2002, a survey conducted by the Baden-Württembergischer Landesverband Hochbegabung e.V. among 252 highly gifted association members between the ages of 5 and 30 revealed a rate of ADHD-I of 4 % (80 % of whom were boys) and of ADHD-HI of 4.8 % (83 % of whom were boys), i.e. 8.8 % ADHD. Limiting the survey to children with an IQ of 130 or more resulted in an ADHD rate of 6.6%.7 The result indicates an existing correlation, even if the restriction to club members limits the interpretability, as people who have no problems at all with an issue that concerns them are generally less likely to have a reason to join a club. This study also reports on many studies on IQ and ADHD that confirm a correlation.
These studies may be a reflection of the increased rate of ADHD in people with lower IQs, making ADHD less likely in those with average IQs.

One study determined an average IQ of 107.88 from 511 ADHD sufferers. Whether the test subjects were tested with or without medication was (as is usually the case) not reported.8
In a lecture, Barkley cited an IQ reduction of 7 to 10 IQ points in ADHD and justified this by stating that the same genes are involved as those for giftedness.9 Another study also found reduced IQ values in ADHD.10 The lowest IQ values were found for persistent ADHD and the (relatively) highest for late-onset ADHD. This study also did not differ according to medication status.

One study found a correlation between high intelligence (IQ 130 and above) and a medical diagnosis:11

  • increased risk of mental disorders (1.20-fold risk)
  • increased risk of physiological diseases (1.84-fold to 4.33-fold risk)
    • ADHD: 1.8 times the risk
    • Autism spectrum: 1.2-fold risk (DSM-IV diagnoses of autism, Asperger’s or other pervasive developmental disorders)
    • Affective disorders: 2.82-fold risk (depression, dysthymia, bipolar)
    • Anxiety disorders: 1.83-fold risk (generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder)
    • Food allergies: 2.59 times the risk
    • Environmental allergies: 3.13 times the risk
    • Asthma: 2.08 times the risk
    • Autoimmune diseases: 1.84 times the risk

Eckerle reports a fascinating similarity between giftedness and ADHD from a neurological perspective.12

Even if a correlation between HB and ADHD were to be proven one day, against the background that ADHD and significant underachievement also correlate, it could at best be deduced that particularly high and particularly low IQs are equally associated with an increased risk of ADHD.

2. Intelligence and IQ in ADHD

2.1. Definition of intelligence

Intelligence is not a fixed scientific measure, but a concept that is defined in a variety of ways.
According to Newton and McGrew’s definition, general intelligence comprises eight broad components:13

  • Fluid thinking (abstract thinking ability)
  • Crystalline general knowledge
  • Visual-spatial ability
  • Long-term memory
  • Auditory processing
  • Information processing speed
  • Short-term memory
  • Quantitative knowledge

as well as additional skills such as psychomotor skills14

In his model of the “theory of multiple intelligences”, Gardner distinguishes between eight independent intelligences:

  • Linguistic
  • Musical
  • Logical-mathematical
  • Spatial (which characterizes architects, for example)
  • Physical-kinesthetic (common among athletes and dancers)
  • Natural history
  • Interpersonal intelligence (facilitates work with others)
  • Intrapersonal (ability to self-reflect)

Common parts of working memory and short-term memory correlate with intelligence.15
The efficiency of working memory is a decisive factor in the measure of intelligence.
Gifted people thus automate their thinking. Highly gifted people do not simply think more than normally gifted people, but they use their brain more efficiently. This more efficient use is achieved, among other things, by automating processes that normally gifted people perform with active thinking (working through individual thinking steps in the frontal cortex) and outsourcing these automated thinking processes to the hindbrain cortex.16

Automation is not something that only the highly gifted can do.

Example: Learning to drive a car. The first few attempts are exhausting: consciously coordinating all the levers, switches, pedals and steering wheel and paying attention to the traffic at the same time is tedious. After some time and practice, however, the brain has automated these processes and you can operate the vehicle almost intuitively and concentrate fully on the traffic. Some drivers who drive very little after their driving test do not achieve this level of automation.
Anyone who has automated a process usually has considerable difficulty teaching another person these automated processes (e.g. driving a car). To do this, the person must first make themselves aware of the automated processes again.
So anyone can automate. Highly gifted people just have the ability to automate faster.

The hindbrain cortex is also the center of visual processing. It is therefore not so wrong when people who have internalized something and have achieved intuitive access to it say: “I see it”.

2.2. IQ measurements for ADHD

Among other things, working memory is impaired in ADHD sufferers. Intelligence tests usually also measure working memory.
Optimal treatment, be it successful neurofeedback or medication with stimulants, relieves the reduced IQ caused by ADHD symptoms (especially the massive impairment of working memory) of this burden - the disruption of working memory is reduced.
The ADHD impact on IQ can be up to 20 IQ points in individual cases.17 In individual cases it can be 30 points or more, on average it could be around 10 IQ points.
ADHD sufferers often perform better on the RAVEN intelligence test than on the HAWIK. The RAVEN is geared more towards abstract thinking.17

“Stimulants can never improve intelligence as such, but they do make it available to the person affected by ADHD. Follow-up observations show that a drop in IQ of up to 15 % can occur in the absence of treatment, but that conversely an increase in IQ of the same magnitude can be expected with stimulant treatment.”1819

A Swedish placebo-controlled study found a mean improvement in IQ of 4.5 points in children with ADHD aged 6-11 years after 9 months of treatment with amphetamine sulphate.20

Of 19 participants with ADHD-HI according to DSM III-R, 12 responded very well to neurofeedback training in which beta was trained up and theta down (40 sessions). The other 7 showed less improvement. In the responders, the IQ improved by 10 points (from 112 to 122) in addition to the symptoms.21 Other sources report a difference of 20 IQ points between acute and inapparent (medicated) symptom states.22

One of the few studies that provides information on the IQ of the test subjects and the medication of the participants came to an IQ of 109 for the participating affected persons (22% of whom were unmedicated) and an IQ of 116 for the participating non-affected persons.23 The exclusion criterion for participation was an IQ below 80, so there is no significance regarding the overall IQ average of ADHD sufferers. The study can only serve as a reason to assume that the IQ average would have been more balanced if all affected test subjects had been given medication.

A study with n = 61,640 test subjects showed that the results for admission to higher educational institutions of ADHD sufferers on medication were significantly better (by 4.8 out of a possible 200 points) than those of ADHD sufferers not on medication.24

A case of an increase of 30 IQ points after 3 years of ADHD therapy was reported in a forum.25

The statement “ADHD has nothing to do with giftedness”, in the sense of “giftedness and ADHD do not correlate” or “the IQ of ADHD sufferers and non-affected people is the same”, can therefore not be correct (in this global form), as ADHD obviously has an influence on examination and test results, which - like IQ tests - are dependent on usable IQ.

2.2.1. Questions about the IQ test procedures when comparing ADHD sufferers and non-sufferers

One important question is:
Were the ADHD sufferers whose IQ was compared with that of non-affected people tested with or without medication? Very few studies provide information on this, which already gives rise to considerable doubts about the reliability of conclusions regarding the IQ of those affected. Were the ADHD sufferers tested with medication and were they optimally adjusted?

If the IQ of only medicated ADHD sufferers and the average of non-affected people is the same, the IQ results of unmedicated ADHD sufferers would have to be significantly (approx. 10 IQ points) below the average of non-affected people, because the impaired working memory (short-term memory) affects the IQ of unmedicated ADHD sufferers. However, such test results are not known.
Another argument against this assumption is that in this case a reduced IQ would be a recognizable symptom of (untreated) ADHD and would therefore have been included in the diagnosis. This is also not reported.
Moreover, a comparative test only with ADHD sufferers on medication would have been so unusual that it would have been reported. Were the ADHD sufferers tested without medication?

The following options are then available:

Option 1:

The evaluations of the IQ tests were carried out excluding the working memory component. But then the statement “The IQ of ADHD sufferers and non-affected people is the same” would be wrong and would have to be qualified with “if you exclude working memory”. We have not yet found such a restriction anywhere.

Option 2:

Other areas of the brain of ADHD sufferers can compensate for the below-average working memory. However, the other areas of the brain of ADHD sufferers would then function better on average than those of non-affected people. This would be nothing other than a partially higher aptitude, which (coincidentally?) is just as high that the IQ impairment is compensated for by the impaired working memory.
This seems very unlikely. Moreover, such a result would be so surprising that it would probably have been the subject of reports. Was no attention paid to the medication?

Such tests would be useless due to the influence of impaired working memory in ADHD on IQ.
Since the above-mentioned alternatives to the influence of medication were not mentioned in most of the studies, we suspect this variant.

2.2.2. Conclusions for IQ test procedures when comparing ADHD sufferers and non-sufferers

In our opinion, the following applies to IQ tests of ADHD sufferers:

For a comparison of the IQ average of ADHD sufferers with that of non-affected persons:

  • The IQ sub-measurements for working memory must be evaluated separately.
  • When comparing ADHD sufferers / non-affected persons, only optimally medicated persons may be tested for the IQ tests of ADHD sufferers (medication optimally adjusted by a doctor and medication taken during the test).
  • As medication can generally only alleviate ADHD symptoms, but not completely eliminate them, even this would only provide limited real comparability.
  • It would at least be interesting to see whether the respective test results would change significantly if, for the IQ matching of the test subjects, the IQ was matched once from non-affected to optimally medicated affected persons and once from non-affected to unmedicated affected persons.

For the treatment of ADHD sufferers:

  • Successful treatment makes the intelligence that is actually present and impaired by the ADHD symptoms (partially) available again.
    Of 19 participants with ADHD-HI according to DSM III-R, 12 responded very well to neurofeedback training in which beta was trained up and theta down (40 sessions). The other 7 showed less improvement. In the responders, the IQ improved by 10 points (from 112 to 122) in addition to the symptoms.21

2.3. Influence of ADHD subtype on IQ?

According to a (single) study, the IQ of all ADHD sufferers was 15 points lower, and the IQ of ADHD-C sufferers was significantly lower than that of the predominantly inattentive (ADHD-I) or the predominantly hyperactive/impulsive ADHD-HI subtype. Only in the predominantly hyperactive/impulsive ADHD-HI subtype was the IQ comparable with the control group.26 However, even the abstract of the article contradicts the reported values.
Our impression is not the same.

2.4. Influence of comorbidities on IQ measurement

It should also be noted that partial performance disorders often occur as comorbidities in ADHD, among other things:

  • Reading and spelling difficulties (dyslexia)
  • Dysgraphia
  • Dyscalculia

Their effects can have an influence on the measurement results in the linguistic or mathematical area. When measuring the overall IQ, this could result in a value that is too low in view of the ability to think abstractly and analytically.27
For a proper comparison of the IQ of ADHD sufferers with non-affected persons, such comorbidities would have to be excluded.
Partial performance disorders in the article Comorbidity

2.5. Influence of learning ability on IQ

Although IQ is basically genetically predisposed, this predisposition includes an average deviation of 21 IQ points as a random variance measure. This can be eliminated with a suitably high number of test subjects (n).
What cannot be eliminated in IQ tests of ADHD sufferers, on the other hand, is that IQ in schoolchildren continues to be significantly

  • From the social environment and
  • From the ability to learn

is influenced.
Children who were adopted by more socially advantaged parents from a socially disadvantaged family only remained in school until the 6th grade in 17% of cases and developed an IQ 14 points higher than their biological siblings who grew up in the socially disadvantaged family of origin, 66% of whom remained in school until the 6th grade.28 This experience is consistent with other findings.

ADHD sufferers are symptomatic of reduced attention and concentration. It is plausible that children who are less able to learn for psychological reasons also suffer limitations in IQ development (regardless of their genetic disposition to intelligence).

However, these facts cannot be easily reconciled with the statement that the IQ of people with ADHD does not differ from that of people without the disorder.

2.6. Genes shared by ADHD and IQ

One study reports more than 30 genes with a correlation between ADHD and IQ.29

2.7. Intelligence deviation as a relevant factor for ADHD?

The finding that the IQ of ADHD sufferers on average corresponds to that of non-affected persons does not necessarily mean that intelligence is not a significant influencing factor in relation to ADHD.
In the case of schizophrenia, it is known that normally gifted people are affected less frequently, whereas gifted and less gifted people are affected more frequently than average. The overall average of those affected may correspond to the overall average (100) - but IQ is still a significant factor.
Schizophrenia is also highly dependent on dopamine levels. The positive symptoms result from a dopamine level that is too high, the negative symptoms from a dopamine level that is too low. The negative symptoms show certain parallels to ADHD symptoms.

Apart from the studies cited by Simchen18 in30, which point to different “IQ types” in ADHD, we are currently unaware of any other specialist publications on such distributions in ADHD.

It is conceivable that a greater deviation in IQ, both upwards and downwards, represents a stressor in its own right insofar as this “being different” makes it more difficult to belong to groups. It is plausible that being an outsider can be a stress factor. This is why a differential diagnosis of unrecognized giftedness is common in ADHD.

ADHD is also a valid construct in connection with high intelligence. ADHD and IQ are negatively correlated in almost all phenotypic and cognitive constructs. Therefore, IQ should always be considered as a potential moderator in ADHD studies.31

2.8. Speculation: Do stress and increased sensitivity train intelligence?

Rats that grow up in enriched environments develop a thicker cortex. Based on this, it is conceivable that the increased sensitivity that we perceive to correlate with ADHD and giftedness as the equivalent of enriched perception leads to a thicker cortex (which also develops later).

Enriched environments, HEE, are housing conditions with increased social interaction and sensory and motor stimulation.32
Enriched environments activate the HPA axis33 and increase performance in various behavioral tests in rodents and recovery from central nervous system damage in rats and slows neurodegenerative aging processes. This improvement was not seen in adrenalectomized rats, which cannot produce corticosterone (the main stress symptom in rodents).
Increased neurotrophin expression (e.g. nerve growth factor, NGF) and the associated increase in neurogenesis in the hippocampus are suspected as a possible cause. Furthermore, the stress-induced increase in dopamine and acetylcholine in the PFC is reduced, which promotes stress resistance. In addition, the release of the stress hormone cortisol is reduced during mild acute stress.34

The effect of enriched environments appears to be age-dependent. Positive effects can already be seen in childhood. However, the greatest benefit was observed in middle adolescence. Enriched environments resulted in improved selective and auditory sustained attention performance, increased exploration and food-gathering behavior and a significant decrease in corticosterone levels as well as reduced anxiety levels.35
Middle adolescence is also the period in which there is the greatest vulnerability to the “second hit” with regard to the development of mental disorders in adulthood. This is supported by the findings of Heim and Binder, according to which stress levels in adolescence can lead to an increase in stress levels in early childhood.36

Since it is known from giftedness research that IQ can change by 10 points within 10 years, and since the combination of stress sensitivity and special talent seems to occur unnaturally frequently, we have developed the hypothesis that stress has its own mechanism of action that promotes IQ.
This could explain why the character traits attributed to ADHD sufferers as positive characteristics in the ADHD literature and the traits attributed to gifted people in the literature on giftedness show such surprising similarities.
This hypothesis could be supported by the fact that mild stress leads to a slight increase in dopamine and noradrenaline levels in the PFC (but not directly to an increased IQ). Only severe stress increases the levels in such a way that the PFC is “switched off” and behavioral control is transferred to other areas of the brain.
More frequent mild stress could therefore increase cognitive performance. This could have an influence on IQ in certain constellations.

3. Giftedness and mental disorders

3.1. Common genetic roots of intelligence and mental disorders

Intelligence has a genetic component. Not everyone who inherits such genes is or will become highly gifted. And you don’t have to have exactly these genes or these genes to be gifted - at best, it increases the chances. People who have been given genes that are favorable for giftedness also need an (early childhood) environment that enables the manifestation, the actual development of this genetic disposition.

Up to this point, the development of giftedness is no different from the development of mental disorders: Gene disposition x environment = manifestation.
However, the connection between giftedness and mental disorders, or at least certain mental disorders, goes further.
There are genes that modify the formula gene x environment = manifestation - the formula is then rather gene x environment² = manifestation.
We call these genes “chance-risk genes”. It would be more accurate to call them chance-risk gene polymorphisms, because 99% of human genes are the same, but they all differ in various subtypes (polymorphisms). In the interests of readability, we have therefore shortened the wording somewhat.

We currently know of 6 opportunity-risk genes. The most important are

  • COMT: Met158Met
  • DRD4: 7R
  • 5HTTPR: short

We suspect that these gene variants are the basis for increased sensitivity and therefore vulnerability. If carriers of these genes receive special support, they develop better than other people. If carriers of these genes are neglected or mistreated, they develop worse than other people. Those affected are sometimes referred to (rather esoterically) as orchid children.3738

Chance-risk genes could also be described as genes that react particularly intensively to positive and negative environmental influences. A more detailed description of how chance-risk genes work and where to find them can be found at How ADHD develops: genes + environment. A more detailed description of how COMT Met-158-Met influences the dopamine balance in such a way that higher mental performance and greater susceptibility to stress occur at the same time can be found at The neurological cause of attention symptoms, section Dopamine degradation in the PFC by COMT instead of DAT

Just as special support for carriers of opportunity-risk genes often leads to special achievements such as giftedness, neglect or abuse (the severity of which would not harm people without these genes = resilience) leads to particularly detrimental consequences for carriers of these genes - i.e. also to more frequent mental disorders.
Examples of this are ADHD and borderline.

Borderline correlates genetically significantly with the COMT Met158Met polymorphism, which is further enhanced when the COMT Met158Met and 5-HTTPR-short allele gene polymorphisms coincide.39
It is plausible that the combination of several opportunity-risk genes further increases sensitivity and vulnerability.

The hypothesis of Andrea Brackmann, who noticed a conspicuous number of at least partially gifted people among her borderline patients, confirms that the five times slower dopamine degradation in the PFC due to COMT Met158Met compared to COMT Val158Val generally leads to increased mental performance and increased susceptibility to stress.40

Against this background, it no longer seems inconclusive to us that genes that have such intensive effects on the psyche can cause typical character traits similar to those attributed to gifted people and ADHD sufferers.

3.2. Common environmental causes of intelligence and mental disorders

Newborn Brown Norway rats, which are known for their long and healthy lifespan, were separated from their mother once for 24 hours on the 3rd day of life. At the age of 30 months, they differed considerably from the siblings that remained with their mother:
The learning ability in animals that had been separated from their mother for 24 hours two and a half years earlier was either particularly good or particularly poor, but hardly average. In contrast, the majority of their siblings that had not been separated from their mothers had average learning ability and only some were good or poor learners (normal distribution).41

3.3. Increased intelligence and sensitivity

One study suspects a correlation between high intelligence (IQ 130 and above) and increased sensitivity.42

4. Delayed cortex maturation in ADHD as in giftedness

Highly gifted people differ from normally gifted people in that the maturation of the cortex thickness is significantly delayed. This delayed development of cortex thickness is impressively similar to that of ADHD sufferers.1243

The higher the giftedness, the later the first maximum cortex thickness is reached. In highly gifted people, the first maximum cortex thickness (approx. 4.85 mm) is reached at 11.1 years, in above-average (but not highly) gifted people (4.85 mm) at 9 years, in average and weakly gifted people (4.75 mm) at around 6 years. In ADHD sufferers, the peak of cortex thickness (4.85 mm) is reached at 10.5 years.

The thinner the cortex, the greater the symptoms of inattention in ADHD.44
In 8 to 15-year-old boys with ADHD, the cortical thickness was unchanged.45 Further studies confirm that the reduced volume in various brain areas observed in children with ADHD no longer persists in adulthood.46 This is consistent with the finding that only a later maturation of the brain volume maxima occurs.

From the fact that the amount of noradrenaline metabolites (NE degradation products) in the urine of ADHD sufferers normalizes with and further after puberty, parallel to the decrease in (child-typical) ADHD-HI symptoms, it is concluded that there is a brain maturation delay in ADHD.47
Such a “brain maturation delay” is also found more frequently than average in carriers of the DRD4-7 allele polymorphism.48 Increased sensitivity is associated with the DRD4-7 polymorphism as a risk/opportunity gene. More on this at How ADHD develops: genes or genes + environment
Increased sensitivity, in turn, correlated very strongly with giftedness according to our earlier perception, although this is not covered by the current data known to us.

As a result, the facts described reinforce the assumption of neurological similarities between gifted people and ADHD sufferers.

5. Similar character traits of gifted people and ADHD sufferers

In addition to the unpleasant symptoms, the ADHD specialist literature unanimously names a very typical bouquet of positive (character) traits of ADHD sufferers.
It is interesting to note that the specialist literature on gifted people also identifies special character traits in gifted people. These positive characteristics mentioned in the specialist literature on ADHD on the one hand and giftedness on the other show a degree of similarity that can no longer be explained by chance.
Unfortunately, this correspondence is rarely discussed in the specialist literature.30.

We have therefore begun to collect a detailed overview of the matching and differing traits, including the respective sources. However, the statements about traits in ADHD and giftedness are largely based on the subjective impression of the authors. Not all traits have been investigated in studies.

One of our earlier working hypotheses was that these character traits may not come from ADHD or giftedness itself, but could be caused by increased sensitivity (as part of the construct of high sensitivity according to Aron).
In our opinion, ADHD is almost always accompanied by increased sensitivity. ADHD involves a weakness in stimulus filtering,49 whereby, in our understanding, a weakness in stimulus filtering is merely another term for increased sensitivity.
However, the hypothesis that giftedness also correlates with increased sensitivity (as part of the construct of high sensitivity according to Aron) was not supported by the data from the symptom test (n = 2,000, as of July 2020).
One study reports a significantly increased sensitivity in the self-perception of gifted people.50

A helpful summary of the positive character traits of ADHD with a number of references can be found on ADHSpedia.51

5.1. Corresponding traits of giftedness and ADHD

  • Strong sense of justice
    • For ADHD 52 53 54 51 5556
      • A sense of social fairness57
    • In autism spectrum disorders (ASD), the sense of justice seems to be even more pronounced58
    • For giftedness50
  • Sensitive
    • For ADHD59
    • For giftedness60
  • A lot of compassion for others
    • For ADHD5251
      • Empathy may be a strength of ADHD-I rather than ADHD
    • For giftedness
      • Empathy61
      • Sees so many possible alternative interpretations that an appropriate social response is made more difficult62
  • Helpful
  • Caring
    • For ADHD52
  • Good powers of observation
  • Focus and perspective
  • Quick comprehension
    • For ADHD6352
    • For giftedness50
  • Curiosity
    • For ADHD645251
    • For giftedness
      • Constantly asking why65
  • Are explorers, and as such are prepared to take risks
    • For ADHD52
  • Diversity of interests
    • For giftedness50
  • Open-mindedness
  • Approach others openly
    • One study found only a very slight increase in openness in ADHD overall, with the increase more likely to occur in those with attention and inhibition problems and slightly reduced in those with increased delay discounting and atypical working memory/verbal fluency.66
  • Enthusiastic, passionate
    • For ADHD52
    • For giftedness67
  • Creativity
    • Creative
    • Original problem solving
      • For ADHD5268
      • With giftedness: more divergent thinking 72
    • Are good at making connections
      • For ADHD52
      • With giftedness: more divergent thinking 72
    • Being able to look at things from different perspectives
      • For the gifted:73
        This can also go to stressful extremes in the case of giftedness:
        • Too many aspects in the head at the same time, so that this confuses and burdens73
        • Always have to look at all sides, to the point of complicating the simple things65
    • Imaginative
    • Inventiveness57
  • Aversion to monotonous tasks
    • For giftedness72
      • Monotonous activities with a lot of repetition (memorizing vocabulary, learning notes, learning to write) seem not only boring to gifted people, but also contradict their way of thinking75
  • Rambling, digressive
    • For giftedness73
      • Digress slightly from the topic
      • Become too detailed
  • Decision problems
    • For giftedness:
      • Some people think about the pros and cons until the discussion is over73
      • Always have to consider all sides, to the point of being unable to make decisions65
      • Too many aspects in the head at the same time, so that this confuses and burdens73
    • With ADHD: typical pattern, especially with ADHD-I subtype
  • Ambition
    • For ADHD52
  • Perfectionism
    • For giftedness50
  • Agile, maneuverable, flexible7452
  • Spontaneous
  • Intuition
  • Playful into old age
    • For ADHD52
  • Can do many things at the same time
    • For ADHD52
  • Often a pronounced love of animals and nature
  • Often amazing knowledge / skills in areas of great interest
  • Ability to hyperfocus (in case of special interest)
    • For ADHD: phenomenon of hyperfocus
      • According to a study, unmedicated ADHD sufferers spent more time studying than non-affected people and less time playing computer and video games or playing with others.76
    • For giftedness
      • Up to task switching problems77
  • More intensive perception
    • For giftedness7850
      • Noise sensitivity71
      • Sensitive to light71
      • Sensitive to odors71
      • Touch sensitive71
      • Sensitive to pain79
      • Emotional80
  • More intense feeling
  • Intense emotions
    • For giftedness7882
      • Movies can be extremely emotionally involving778350
    • Correlate with
      • Creativity84 and
      • Ability to structure other people
        • For ADHD85
  • Constantly under power
    • For giftedness77
    • For ADHD
      • Inexhaustible energy74
    • For ADHD-HI (less for ADHD-I)
      • Core symptom due to inability to recover / lack of shutdown of the HPA axis
  • Aversion to small talk
    • For giftedness86
  • Great relief when meeting people of the same species
    • For gifted children: Mensa e.V.
    • For ADHD: self-help groups
    • For ADHD87
    • Preference for solitary/withdrawn/individual activities

The specialist literature also identifies typical disadvantageous character traits in gifted people. If one is not inclined to regard the similarities in positive traits as a coincidence, the negative traits that also occur more frequently in giftedness and ADHD could provide an indication of the cause of these traits.

Highly gifted people are said to have a communication behavior that “goes one step towards Asperger’s”.88

The following character traits are frequently cited in specialist literature for highly creative people:

  • Difficult social behavior899091
  • Socially harsh behavior8990 91
    • E.g. by expressing the perceived motives of others, which are not perceived by others and of which those affected may not even be aware92
  • Repellent/rough/rough9390
  • High psychotic personality values9490
  • Stronger negative affects9590
  • Greater physiological stress9590
  • More self-oriented perfectionism95

In our opinion, the list mentioned so far evokes strong associations with ADHD traits. However, a match is at least questionable for:

  • More irrational beliefs95

Conspicuous features for the social environment, which often coincide in ADHD and giftedness:

  • Feeling of isolation
  • Highly gifted: emotionally but at an age-typical level, intellectually very well developed
  • ADHD: emotional development delayed compared to intellectual development
  • Constant critical questioning of authorities
  • Very individualistic
  • Tendency to want to determine situations alone

However, we consider these factors to be a consequence of being different rather than a congruent cause.

Conspicuous features in relation to work behavior and interests

  • Strong immersion in certain problems (HB: specific interests, ADHD: hyperfocus)
  • Perfectionist demands
  • Boredom to the point of refusing to work on routine tasks

Conspicuous features in Kindergarten and school

  • Boredom (HB: even more frequent, ADHD with inactivity)
  • Disturbing the other children to get attention (Class clown)
  • Outsider position, the child feels misunderstood

5.2. Non-matching traits of giftedness and ADHD

5.2.1. Specific traits of ADHD

The following traits of ADHD are not considered typical in gifted people.

  • Great toughness / endurance
    • For ADHD52
      • Physical fitness and enjoyment of exercise57
    • In our opinion, however, only in the case of high intrinsic interest or as a result of the treatment effect of endurance sports in ADHD
  • Warm-hearted
  • Little resentful56
  • Willingness to take risks
    • For ADHD85
  • Intense emotions correlate with good memory, as what is experienced is better remembered when there is intense emotion at the same time; however, working memory is impaired in ADHD. We are not aware of any impairment of long-term memory.
  • Love of physical work
    • In our opinion symptomatic at best as a typical stress reduction reaction in ADHD
  • Need for harmony56
  • Sense for situation comedy57
  • Prickly charm57

In ADHD, changes in the personality traits of the Big 5 are reported:

  • Neuroticism (significantly increased)
  • Conscientiousness (significantly reduced)
  • Compatibility (reduced)
  • Extraversion (reduced)
  • Openness to experience, on the other hand, has hardly changed.

Find out more at Personality traits changed In the article Complete list of ADHD symptoms according to manifestations in the chapter Symptoms.

5.2.2. Specific traits of gifted people

The following traits of gifted people are not considered typical for ADHD.96979899100

  • Conspicuous features in relation to learning and thinking

    • High level of detailed knowledge and very good understanding of interrelationships50
    • Unusually pronounced Vocabulary and linguistic expression50
    • Early reading
    • (Early) interest in books that are well above the age level
    • Preference for independent work, high goals
    • Intrinsic motivation style50
  • Conspicuous features in Kindergarten and school

    • No interest in age-appropriate activities or in the subject matter of the school year
  • Conspicuous features for the social environment

    • Little interest in age-typical activities
    • Preference for verbal rather than physical confrontations
    • Choice of significantly older friends

5.3. No change in positive traits due to ADHD medication

ADHD medications, especially methylphenidate, do not change any (positive) traits.

There are indications that the personality profiles of ADHD sufferers change with long-term medication.101 However, the development under medication (methylphenidate) of the 81% MPH responders changed in almost all measured dimensions away from the (unfavorable, personality disorder-associated) extremes towards a more balanced profile (which is less associated with personality disorders).102
The changes consistently demonstrate a shift away from a more unstable personality towards a more stable one.

ADHD sufferers consistently report that they do not notice any change in their personality when taking the appropriate dosage. The typical statement is that they are much more themselves as a result of the medication. Other perceptions arise when overdosing or when non-affected people take ADHD medication.

However, stimulants dampen the limbic system. Stimulants can therefore be associated with impaired emotionality, particularly in the case of overdose. Barkley explained in a lecture,103, that stimulants can dampen emotions by inhibiting the limbic system, which is not affected in ADHD per se. The higher the dosage, the more the limbic system (including the amygdala) is inhibited. This naturally reduces affect. An individually excessive stimulant dosage, especially an overdose, can therefore lead to a restricted emotional experience, which occurs in around 20 % of patients treated with stimulants.
In this context, Barkley refers to the increasingly common combination medication (stimulants and atomoxetine or stimulants and guanfacine) in order to cumulate the positive effects and spread the side effects, which are usually located in different areas, and thus reduce them. In contrast to stimulants, atomoxetine does not affect the limbic system and therefore does not impair emotional perception. Atomoxetine activates the ACC and the frontal lobe and thus directly influences executive functions. Stimulants improve attention, cognition, executive functions and working memory. They are less suitable for improving emotion regulation.

6. Differential diagnosis required

The fact that a differential diagnosis for unrecognized giftedness is necessary in cases of suspected ADHD does not reveal any neuro(physio)logical or biological connection between ADHD and giftedness. The need for differential diagnosis arises solely from the fact that unrecognized gifted people (especially those with individually limited social skills) often live an outsider’s existence just like those with ADHD and do not feel that they really belong. Such an outsider position can cause massive social stress. This stress can be misinterpreted as ADHD symptoms, which should therefore be ruled out by means of differential diagnostics.
ADHD symptoms are stress symptoms

Typical forms of expression are, for example

  • Outsidedness, which is sometimes attempted to be compensated for with class clown or other roles
  • The feeling of not belonging
  • Self-esteem problems including the resulting comorbidities ranging from depression to social phobias

The hypothesis that gifted people cannot have ADHD is definitely incorrect. We know a relevant number of gifted and highly gifted people who have a clear ADHD-HI or ADHD-I diagnosis.

Nevertheless, there are supposed specialists, such as a specialist in psychiatry at an ADHD-HI center in a major German city, who in 2016 sent away an academic suffering from massive ADHD-I, who was already successfully taking ADHD medication, after 35 minutes of questionnaire anamnesis (without any tests) with the words: “You can’t have ADHD-I. You have a doctorate, a degree, and can live as a self-employed person. You have a doctorate and have studied and can live as a self-employed person. You can’t have ADHD-I.” The problems of those affected read like a sample collection of ADHD-I symptoms.

In unrecognized gifted people (especially children), ADHD-like symptoms are attributed to problems with the social environment.104

The feeling of being an outsider and not belonging can lead to reduced self-esteem Self-esteem can lead to reduced self-esteem.105
Reduced self-esteem causes psychological stress.106

In the case of unrecognized gifted people, underchallenge can lead to those affected becoming bored and - depending on their predisposition - dreaming themselves away into an inner world (ADHD-I confusability) or disrupting lessons, e.g. to get attention (ADHD-HI confusability). In addition, (over-)adjustment phenomena can occur when those affected look to themselves for “blame”.106 This in turn can result in them deliberately working slowly or making mistakes and thus neither being recognized as highly gifted nor expressing their frustration to the outside world. Constant underchallenge and the resulting lack of motivation can lead to a complete refusal to perform.107
See also: Mental saturation.

7. Giftedness and coping skills

The specialist literature on giftedness agrees that gifted people also have an above-average ability to cope due to their special abilities. Coping strategies are coping strategies to mitigate or avoid impairments or deficits (regardless of their nature or cause) through appropriate behavior. Coping strategies do not eliminate ADHD. Coping merely means that the person affected is better able to deal with the symptoms or knows how to avoid situations in which they would suffer from the symptoms.108

A distinction must be made between severity and consequences. While a study of ADHD sufferers with an IQ of 120 and above found no differences in ADHD severity apart from slightly lower cognitive impairments109, another study came to the conclusion that high intelligence predicts less severe effects of ADHD in the future if ADHD is present.110 Another study even found a massively higher incidence of ADHD in gifted individuals.111

If it is assumed (without reference to studies) that highly gifted people do not have ADHD more frequently than the average, the same logical deduction arises as under 1 (IQ tests and working memory in ADHD): If highly gifted people have better coping strategies, they should have a lower rate of (diagnosed) ADHD. However, if gifted people are diagnosed with ADHD just as often as non-gifted people despite their improved coping strategies (which should mask ADHD better), then gifted people (without their coping strategies) have ADHD as often as they can make up for with coping strategies. The difference may not be too great, because even good coping skills can at best make up for mild ADHD or mitigate the severity of ADHD effects. Nevertheless, the difference is there.

8. ADHD testing through intelligence tests?

It would be at least theoretically conceivable to determine the impairment caused by ADHD using appropriate intelligence tests.

Intelligence tests usually also measure working memory. For the differential diagnosis of ADHD for (non-)existing giftedness, only IQ tests that report the working memory values separately in order to determine the ADHD indicator of impaired working memory are therefore suitable. The person concerned must not have taken any medication for this.

Repeating the IQ test while taking medication after the dosage has been adjusted by a doctor should show a significant difference in working memory in ADHD sufferers. This would be a strong indication of ADHD.

9. More about ADHD and giftedness:

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  3. z.B. Besonders Begabte Kinder e. V., ADHS und Hochbegabung?, abgerufen am 20.09.15

  4. Budding, Chikedel (2012): ADHD and giftedness: a neurocognitive consideration of twice exceptionality. Appl Neuropsychol Child, 2012; 1(2): 145-51, zitiert von Bachmann, AD(H)S und/oder Hochbegabung, Broschüre der Medice Arzneimittel Pütter GmbH & Co. KG, Seite 13

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  7. Müller (2012): Hochbegabung und ADS/ADHS – Teilergebnisse einer LVH Vereinsumfrage in Fitzner, Stark (Hrsg., 2013): Genial, Gestört, Gelangweilt? ADHS, Schule und Hochbegabung, Seite 219 ff

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  9. Barkley (2018): Vortrag an der Universität Göteborg, ca. Minute 38

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