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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 encountered 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 people with ADHD have a lower2 or no higher IQ than non-affected people.3 Some report just below average to normally distributed intelligence with 10% of people with ADHD having an IQ of 120.4
A meta-analysis suggests that only a subgroup of adults with ADHD (e.g., those with comorbid disorders) have lower general intellectual abilities compared to adults without ADHD.5 Another study reports a 15-point reduction in IQ in a subgroup of people with ADHD, more often female, with increased mental health problems and a possible link to perinatal complications 6

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%).7 Other sources report an ADHD prevalence of 15% with an IQ of 115 and above8 or 5 to 6% of gifted people with ADHD in the verbal IQ range9, which would be significantly above average.
In 2002, a survey of 252 highly gifted association members between the ages of 5 and 30 conducted by the Baden-Württembergischer Landesverband Hochbegabung e.V. revealed a rate of ADHD-I of 4% (of which 80% were boys) and of ADHD-HI of 4.8% (of which 83% were boys), i.e. 8.8% ADHD. If the survey was limited to children with an IQ of 130 or more, the ADHD rate was 6.6%.10 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 odds of ADHD in people with lowered IQs, such that ADHD is less likely in those with average IQs.

One study determined an average IQ of 107.88 from 511 people with ADHD. Whether the test subjects were tested with or without medication was (as is usually the case) not reported.11
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.12 Another study also found reduced IQ values in ADHD.13 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:14

  • 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

A fascinating similarity between giftedness and ADHD from a neurological perspective is reported by Eckerle.15

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. Our hypothesis is that deviations in IQ from the mean correlate 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:16

  • 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 skills17

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.18 The efficiency of working memory is a decisive factor in the measure of intelligence.

Highly gifted people 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.19
Automation is not something that only gifted people can do; they may be better at it.

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, the working memory of people with ADHD is impaired. Intelligence tests usually also measure working memory.
Optimal treatment, be it successful neurofeedback or medication with stimulants, relieves the IQ reduced by the ADHD symptoms (especially the massive impairment of working memory) of this burden - the Disorder of working memory is reduced.
The ADHD impact on IQ can be up to 20 IQ points in individual cases.20 In individual cases it can be 30 points or more, on average it could be around 10 IQ points. Other sources speak of 2 to 5 points21, which seems too low to us.
People with ADHD often perform better on the RAVEN intelligence test than on the HAWIK. The RAVEN is geared more towards abstract thinking.20

“Stimulants can never improve intelligence as such, but they make it available again for the person with 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.”2223

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.24

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.25 Other sources report a difference of 20 IQ points between acute and inapparent (medicated) symptom states.26

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 persons with ADHD (22% of whom were unmedicated) and an IQ of 116 for the participating non-affected persons.27 The exclusion criterion for participation was an IQ below 80, so that there is no significance regarding the overall IQ average of people with ADHD. The study can only serve as a reason to assume that the IQ average would have been more balanced if all persons with ADHD had been medicated.

A study with n = 61,640 subjects showed that the results for admission to higher education institutions of medicated people with ADHD were significantly better (by 4.8 out of a possible 200 points) than those of non-medicated people with ADHD.28

A case of an increase of 30 IQ points after 3 years of ADHD therapy was reported in a forum.29

The statement “ADHD has nothing to do with giftedness”, in the sense of “giftedness and ADHD do not correlate” or “the IQ of people with ADHD and those without ADHD is the same”, cannot therefore 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 people with ADHD with those without ADHD

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

If the IQ of only medicated persons with ADHD and the average of non-affected persons is the same, the IQ results of unmedicated persons with ADHD would have to be significantly (approx. 10 IQ points) below the average of non-affected persons, because the impaired working memory (short-term memory) affects the IQ of unmedicated persons with ADHD. 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 with only medicated people with ADHD would have been so unusual that this would have been reported. Were the people with ADHD 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 people with ADHD is the same as that of people without ADHD” 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 people with ADHD can compensate for the below-average working memory.
This could be an adaptation reaction. It is generally known that the brain is able to shift tasks from “defective” brain areas to “functional” brain areas. The recovery and restoration of abilities in stroke patients through intensive training is based on this mechanism. This neuroplasticity also exists independently of a stroke.
Giftedness correlates with above-average neuroplasticity and slower growth of the cortex (later maximum cortex thickness).
The latter could be an indication that the cortex is less stressed/used/trained than in others. This in turn could possibly be a consequence of faster automation and shifting of brain functions to posterior brain regions.
This mechanism could possibly also explain the observation that people with ADHD who are more gifted are more frequently diagnosed in adulthood (“late onset” ADHD), when they were particularly well able to compensate for the impaired abilities of the brain regions involved in ADHD with other brain regions. 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 people with ADHD with those without ADHD

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

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

  • The partial IQ measurements for working memory must be evaluated separately
  • When comparing people with ADHD with those who are not affected, only optimally medicated people may be tested for the IQ tests of people with ADHD (medication optimally adjusted by a doctor and medication taken during the test)
  • Since medication can usually only alleviate ADHD symptoms, but not completely eliminate them, even optimal medication 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 people with ADHD and once from non-affected to unmedicated people with ADHD

For the treatment of people with ADHD:

  • 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.25

2.3. Influence of ADHD subtype on IQ?

According to a (single) study, the IQ of all people with ADHD was 15 points lower, and the IQ of ADHD-C was also 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.30 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, including:

  • 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.31
For a clean comparison of the IQ of persons with ADHD with non-affected people, 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 people with ADHD, on the other hand, is that IQ in schoolchildren remains 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.32 This experience is consistent with other findings.

People with ADHD suffer symptomatically from a reduced ability to pay attention and concentrate. 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 persons with ADHD does not differ from that of people without ADHD.

2.6. Genes shared by ADHD and IQ

One study reports more than 30 genes with a correlation between ADHD and IQ.33

2.7. Intelligence deviation as a relevant factor for ADHD?

The finding that the IQ of persons with ADHD is on average the same as that of people without ADHD 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 people with ADHD may again 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 Simchen22 in34 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 the context of high intelligence. ADHD and IQ are negatively correlated for almost all phenotypic and cognitive constructs. Therefore, IQ should always be considered as a potential moderator in ADHD studies.35

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.36
Enriched environments activate the HPA axis37 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.38

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 exploratory and food-gathering behavior and a significant decrease in corticosterone levels as well as reduced anxiety levels.39
Middle adolescence is also the period in which there is the greatest vulnerability to the “second hit” in terms of 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.40

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 people with ADHD in the ADHD literature as positive traits and the traits attributed to gifted people in the literature on giftedness have 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 link between giftedness and mental disorders, at least to 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. People with ADHD are sometimes referred to (rather esoterically) as orchid children.4142

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.43
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.44

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 people with ADHD.

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 a single 24-hour period two and a half years earlier was either particularly good or particularly poor, but barely 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).45

3.3. Increased intelligence and sensitivity

One study suspects a correlation between high intelligence (IQ 130 and above) and increased sensitivity.46

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 people with ADHD.1547

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 persons with ADHD, 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.48
In 8 to 15 year old boys with ADHD, cortical thickness was unchanged.49 Further research confirms that the reduced volume in various brain areas observed in children with ADHD does not persist in adulthood.50 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 people with ADHD 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.51
Such a “brain maturation delay” is also found more frequently than average in carriers of the DRD4-7 allele polymorphism.52 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 people with ADHD.

5. Similar character traits of gifted people and people with ADHD

In addition to the unpleasant symptoms, the ADHD specialist literature unanimously names a very typical bouquet of positive (character) traits of people with ADHD.
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 an astonishing and impressive degree of similarity.
Unfortunately, this correspondence is rarely discussed in the specialist literature.34

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.

An earlier working hypothesis of ours 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,53 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 people with ADHD.54

A helpful summary of the positive character traits of ADHD with a number of references can be found at ADHSpedia.55

5.1. Matching traits of giftedness and ADHD

Trait HB ADHD Notes
Strong sense of justice 54 56 57 58 55 59 60 Sense of social fairness61 The sense of justice seems to be even more pronounced in ASD62
Sensitive 63 64
a lot of empathy for others 65 sees so many possible alternative interpretations that appropriate social response is made difficult66 56 55 Empathy may be a strength of ADHD-I rather than ADHD
Helpfulness 56 55 yes
caring yes 56
Good observation skills yes if interested
Focus and perspective yes if interested
Quick comprehension 54 67 56 , if interested
Curiosity 68 (constantly asking why) 69 56 55
Explorers, as such prepared to take risks yes 56
Diversity of interests 54 Frequently changing interests
Open-mindedness yes yes
Open approach to others yes Openness was only slightly increased in ADHD overall, more in individuals with attention and inhibition problems, slightly decreased in individuals with increased delay discounting and atypical working memory / verbal fluency was slightly decreased70
Enthusiastic, passionate 71 56
Creativity 54 ; also known as divergent thinking72 67 56 73 60 74 75 61
Original problem solving divergent thinking 76 56 73
are good at making connections 76 56
Being able to look at things from different perspectives 77 Also as a stressful extreme: too many aspects in the head at the same time, so that this confuses and stresses77; always having to look at all sides, to the point of complicating simple things68 yes
Imaginative yes 56 73
Imaginative yes 78 74
Inventiveness 61
Aversion to monotonous tasks 76 ; monotonous activities with many constant repetitions (memorizing vocabulary, learning notes, learning to write) seem not only boring to highly gifted people, but also contradict their way of thinking79 yes
rambling, digressive 77 easily strays from the topic, becomes too detailed
Decision-making problems think about pros and cons until the discussion is over77; always having to consider all sides, to the point of being unable to make a decision68; too many aspects in the head at the same time, so that this confuses and stresses77 typical pattern, especially with ADHD-I subtype
Ambition yes 56
Perfectionism 54 often dysfunctional perfectionism sometimes extreme with ASD
Mobile, agile, flexible yes 78 56
Spontaneity yes 56 61
Intuition yes yes
playful into old age yes 56
can do many things at the same time yes 56
Often a pronounced love of animals and nature yes yes
Often amazing knowledge / skills in areas that are of great interest yes yes also with ASD
Ability to hyperfocus (when particularly interested) up to task switching problems80 According to a study, unmedicated people with ADHD spent more time studying than non-affected people and less time playing computer and video games or playing with others81
More intense perception 82 54 ; Sensitivity to noise72; Sensitive to light72; Sensitive to smell72; Sensitive to touch72; Sensitive to pain83; Emotional8482 85 54 82 86 ; Movies can be extremely emotional8087 54 Increased sensitivity; correlated with creativity88
Ability to structure other people yes 89
Constantly energized 80 Almost inexhaustible energy78
Aversion to small talk 90 yes
Great relief when meeting people of the same kind Mensa e.V. Self-help groups 91

The specialist literature also identifies typical disadvantageous character traits in gifted people. Provided one is not inclined to regard the similarities in positive traits as 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”.92

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

  • Difficult social behavior939495
  • Socially harsh behavior9394 95
    • E.g. by expressing perceived motives of others that are not perceived by others and that the person with ADHD may also not be aware of96
  • Repellent/rough/rough9794
  • High psychotic personality values9894
  • Stronger negative affects9994
  • Greater physiological stress9994
  • More self-oriented perfectionism99

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

  • More irrational beliefs99

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

  • Feeling of being isolated, of being different, of not belonging
  • Highly gifted: intellectually very highly developed, but emotionally at an age-typical level
  • 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 (with HB: even more frequent; with 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 typically reported in gifted individuals.

  • Great toughness / endurance
    • For ADHD56
      • Physical fitness and enjoyment of exercise61
    • In our opinion, however, only with a high intrinsic interest or as a consequence of the treatment effect of endurance sports in ADHD
  • Warm-hearted
  • Little resentful60
  • Willingness to take risks
    • For ADHD89
  • Intense emotions correlate with good memory, as experiences are better remembered when intense emotions are present; 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 harmony60
  • Sense for situation comedy61
  • Prickly charm61

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

  • Neuroticism (significantly increased)
  • Conscientiousness (significantly reduced)
  • Compatibility (reduced)
  • Extraversion (reduced)
  • Openness to experience, on the other hand, has barely 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.100101102103104

  • Conspicuous features in relation to learning and thinking

    • High level of detailed knowledge and very good understanding of interrelationships54
    • Unusually pronounced Vocabulary and linguistic expression54
    • Early reading
    • (Early) interest in books that are well above the age level
    • Preference for independent work, high goals
    • Intrinsic motivation style54
  • 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

    • Barely interested 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 (positive) traits.

There is evidence that the personality profiles of people with ADHD change with long-term medication.105 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).106
The changes consistently demonstrate a shift away from a more unstable personality towards a more stable one.

People with ADHD consistently report that they do not notice any change in their personality when dosed appropriately. 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,107, 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 in different areas, and thus reduce them. In contrast to stimulants, atomoxetine does not affect the limbic system and therefore does not reduce emotional perception in this way. 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 required 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 with individually limited social skills) often live an outsider’s existence just like people with ADHD and do not feel that they really belong. Such an outsider position can cause massive social stress. Not belonging is the biggest stressor there is for people. It is the stressor that is set by the TSST. In severe cases, 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 may not 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 people with ADHD 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.108

The feeling of being an outsider and not belonging can lead to reduced self-esteem Self-esteem can lead to reduced self-esteem.109
Reduced self-esteem causes psychological stress.110

In the case of unrecognized gifted people, underchallenge can lead to people with ADHD 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 if the person with ADHD seeks to “blame” themselves.110 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.111
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 leads to the person with ADHD being better able to deal with the symptoms or to better avoid situations in which they would suffer from the symptoms.112 In this respect, a high IQ can mask an existing ADHD8113
The coping ability resulting from a higher IQ can help to avoid the subjective suffering that is absolutely necessary for an ADHD diagnosis. We see the danger here that a giftedness-related increased coping ability can lead to the giftedness being “wasted” on compensating for the ADHD, which can deprive the person with ADHD of the opportunity to develop their abilities.114 Therefore, a possible lack of suffering in these cases should be questioned with caution.

A distinction should also be made between severity and Consequences. While a study of people with ADHD with an IQ of 120 or more found no differences in the severity of ADHD apart from slightly lower cognitive impairments115 and one study even found a massively higher incidence of ADHD in gifted people116, most other studies came to the conclusion that high intelligence predicts less severe effects of ADHD in the future117, particularly due to significantly less impaired executive functions in some cases.118119120121

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 in 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) should conversely 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 compensate for mild ADHD, make moderate ADHD bearable or mitigate the severity of the ADHD effects. Nevertheless, there is a difference.

Impulsivity and inattention are essentially moderated by primary intelligence and not by an attention deficit. The lower the IQ, the more ADHD manifests as impaired impulsivity and the less as attention deficit.122 This is somewhat at odds with the finding that higher IQ in ADHD correlated most strongly with fewer attention problems. Even with a high IQ, attention problems predicted school problems less than hyperactivity/impulsivity problems. Attention problems in highly intelligent children are exceptional and impair school performance123

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 are therefore suitable for determining the ADHD indicator of impaired working memory. The person with ADHD 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 reveal a significant difference in the working memory of people with ADHD. This would be a strong indication of ADHD.

9. More about ADHD and giftedness:

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