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Giftedness and ADHD

Giftedness and ADHD

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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 an astonishing number of parallels and points of contact.

A higher IQ correlates with a later ADHD diagnosis in people with ADHD, as do lower hyperactive-impulsive symptoms or a high socioeconomic household status.2 A high IQ and an internalizing ADHD presentation form therefore makes diagnosis more difficult.

1. ADHD diagnostics for giftedness

A more detailed description can be found in the article Giftedness and ADHD.

That high intelligence excludes ADHD is unfortunately still a common misconception. The incidence of ADHD in gifted people is at least as high as in those with normal intelligence.
More on this at ADHD more common with giftedness? in the article Giftedness and ADHD.

However, it is true that higher intelligence is associated with an increased ability to cope with problems. Highly gifted people often have an increased ability to circumvent psychological impairments through special behaviors - so-called coping (compensation strategies).3 ADHD can therefore be more difficult to recognize in gifted individuals.
The view that people who are coping with ADHD do not need treatment for their ADHD is unethical. To expect someone to live with treatable symptoms of a mental Disorder and to deny them treatment when they are suffering from it is against the duty of doctors and psychologists to help. It is ethically correct to allow gifted people to use their giftedness for more meaningful things than neutralizing a deficit that is much easier to treat than any other mental health problem.
It should also be taken into account that treating an existing ADHD can unlock an IQ potential of 5 to 15 points.

Highly gifted people with ADHD can perform like non-affected normal gifted people.4 This means that alarm signs are not visible, which could otherwise promote the timely initiation of a diagnosis.3

One challenge in the differential diagnosis of giftedness and ADHD is the numerous very confusable character traits of giftedness and ADHD. However, as with all other problem cases in differential diagnosis, this can be easily solved if the confusable characteristics of giftedness and ADHD are known.
A detailed description of the similarities and differences between the character traits typical of ADHD and giftedness can be found at Similar character traits of gifted people and people with ADHD in the article Giftedness and ADHD.
In addition to similar character traits, an accumulation of increased sensitivity can also be observed.

The similarity of the character traits could possibly be due to the parallel delayed first maximum of the brain’s cortex thickness. More on this under Delayed cortex maturation in ADHD as in giftedness in the article Giftedness and ADHD.

The feeling of not belonging also occurs more frequently with giftedness, as it does with ADHD. Here, however, the causes could be different.
Weak social skills in combination with giftedness can have serious consequences. Gifted people usually have a different sense of humor, different interests and different ways of thinking than normal gifted people. If this is compounded by weak social skills, gifted people can easily become victims of bullying. Bullying can trigger severe chronic stress, which can cause symptoms similar to ADHD.

Working memory is also often impaired in gifted people with ADHD. IQ tests that evaluate the test areas that make demands on working memory separately often show a serious dip in these areas. This dip can be a good indication of existing ADHD.

ADHD treatment can increase the available IQ (not only in gifted people). We assume an increase of 5 to 10 IQ points. More on this under ADHD puts a strain on IQ / ADHD treatment can release IQ In the article Giftedness and ADHD.

2. ADHD more common with giftedness?

A number of sources claim that people with ADHD have a lower5 or no higher IQ than non-affected people.6 Some report just below average to normally distributed intelligence with 10% of people with ADHD having an IQ of 120.7
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.8 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 9

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%).10 Other sources report an ADHD prevalence of 15% with an IQ of 115 and above11 or 5 to 6% of gifted people with ADHD in the verbal IQ range12, 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 4% ADHD-I (80% of whom were boys) and 4.8% ADHD-HI (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%.13 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.14
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.15 Another study also found reduced IQ values in ADHD.16 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:17

  • 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.18

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.

3. Intelligence and IQ in ADHD

3.1. Definition of intelligence

Intelligence is not a fixed scientific measure, but a concept that is defined in different ways.
According to Newton and McGrew’s definition, general intelligence comprises eight broad components:19

  • 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 skills20

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.21 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.22
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”.

3.2. IQ measurements for ADHD

Among other things, the working memory of people with ADHD is impaired. Intelligence tests usually also measure working memory.
A study of young adults with ADHD (16 to 27 years old, with an IQ average of 80) found that the Processing speed index was even lower than the Working Memory Index, and both were lower than the Verbal Comprehension Index of the Korean Wechsler Test V4.23

Optimal treatment, be it successful neurofeedback or medication with stimulants, relieves the IQ reduced in ADHD by the ADHD symptoms (especially the massive impairment of working memory) of this burden - the disorder of working memory is reduced.

People with ADHD often perform better on the RAVEN intelligence test than on the HAWIK. The RAVEN is geared more towards abstract thinking.24

3.2.1. ADHD puts a strain on IQ / ADHD treatment can free up IQ

There is surprisingly little research on how treatment for ADHD affects IQ.

  • Improvement of IQ through methylphenidate25
  • 2 to 5 (or 7) IQ points26, which seems low to us.
  • a Swedish placebo-controlled study found a 4.5 IQ point improvement in children with ADHD aged 6-11 years after 9 months of treatment with amphetamine sulfate27
  • 6.2 IQ points in total IQ after 6 months of MPH treatment under MPH at test compared to unmedicated test at diagnosis28
    • 2.2 IQ points in the verbal part of the IQ test
    • 8.5 IQ points in the performance section of the IQ test
  • 10 IQ points in responders to neurofeedback treatment (from 112 to 122)29
  • up to 20 IQ points30
  • up to 20 IQ points in individual cases24
    • “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.”3132
  • 30 IQ points in an individual case report in a forum after 3 years of ADHD therapy33

One study investigated the development of IQ with methylphenidate, whereby the children had not taken MPH for at least one week before the control measurement, which is likely to significantly reduce the effect. Nevertheless, a significant increase in overall IQ was found:

  • 2.9 IQ points in total IQ after 1 year of MPH use (n = 103)34

A study with n = 61,640 subjects showed that the results for admission to higher educational institutions of people with ADHD who were on medication were significantly better (by 4.8 out of a possible 200 points) than those of people with ADHD who were not on medication.35

3.2.2. Questions about 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. Even the latest studies (2024) are silent on this question.36

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.37 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. However, the gap of around 5 points is consistent with other studies that did not take medication into account.36

3.2.2.1. 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.

3.2.2.2. 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.

3.2.2.3. 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.

3.2.3. 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 without ADHD, only optimally medicated persons may be tested for the IQ tests of people with ADHD (medication optimally adjusted by a doctor and medication taken during the test), as otherwise the IQ test also measures the performance impairment of unmedicated ADHD instead of just the IQ alone
  • Since medication can usually only alleviate ADHD symptoms, but not completely eliminate them, even optimal medication would only provide limited true 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 restores (at least partially) the intelligence that is actually present and impaired by the ADHD symptoms.

3.3. 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.38 However, even the abstract of the article contradicts the reported values.
Our impression is not the same.

3.4. 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.39
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

3.5. 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).
IQ tests of people with ADHD, on the other hand, cannot eliminate the fact that IQ in school children 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.40 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.

3.6. Genes shared by ADHD and IQ

One study reports more than 30 genes with a correlation between ADHD and IQ.41

3.7. 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 Simchen31 in42 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 “otherness” 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.43

3.8. 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.44
Enriched environments activate the HPA axis45 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.46

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.47
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.48

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.
In this sense, frequent mild stress could increase cognitive performance. This could have an influence on IQ in certain constellations.

3.8.1. 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 of the 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).49

3.8.2. Increased intelligence and sensitivity

One study suspects a correlation between high intelligence (IQ 130 and above) and increased sensitivity.50

4. Giftedness and mental disorders - common genetic roots

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.5152

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

Better performance in intelligence test tasks correlated with an increased dopamine/adrenaline and noradrenaline/adrenaline ratio.53 However, these are blood plasma values that have no real relevance due to the impermeability of the blood-brain barrier for dopamine and noradrenaline.

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 affect 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 even more pronounced when the COMT Met158Met and 5-HTTPR-short allele gene polymorphisms coincide.54
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.55

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.

5. Delayed cortex thickness maximum in ADHD as in giftedness

Highly gifted people differ from normal gifted people in that their cortex thickness is significantly delayed. This delayed development of cortex thickness is impressively similar to that of people with ADHD.185657 Another study comes to the same conclusion, finding a thinner cortex in ADHD, which was most pronounced at the ages of 10 and 11.58

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 cortex thickness is thus 0.1 mm higher in HB as in ADHD and is reached 4 to 4.5 years later.

Mice in which ADHD was triggered by nicotine in the mother during pregnancy showed increased cortex thickness.59

The thinner the cortex, the greater the symptoms of inattention in ADHD.60
In 8 to 15 year old boys with ADHD, cortical thickness was unchanged.61 Further studies confirm that the reduced volume in various brain areas observed in children with ADHD does not persist in adulthood.62 This is consistent with the assumption 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.63
Such a “brain maturation delay” is also found more frequently than average in carriers of the DRD4-7 allele polymorphism.64 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.

Interestingly, higher IQ in children correlated with decreasing cerebral blood flow. This did not occur in the children with ASD with increasing IQ.65

6. 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.42
In a lecture66, Barkley cites a list of New Zealand characteristics that are said to be particularly characteristic of gifted people67 and that are almost universally different from ADHD. However, our impression is that these are predominantly behavioral traits or leadership abilities, which also tend to describe an ideal type of performance-oriented giftedness, i.e. a kind of extreme in the spectrum of giftedness. In this section, on the other hand, we are mainly talking about character traits, which is very different from behaviors or performance abilities.

Below is 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,68 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 ADxS.org symptom test (n = 2,000, as of July 2020).
One study reports a significantly increased sensitivity in the self-perception of people with ADHD.69

A helpful summary of the positive character traits of ADHD with a number of references can be found at ADHSpedia.70

6.1. Matching traits of giftedness and ADHD

Trait HB ADHD Notes
Strong sense of justice 69 71 72 73 70 74 75 Sense of social fairness76 The sense of justice seems to be even more pronounced in ASD77
Sensitive 78 79
a lot of empathy for others 80 sees so many possible alternative interpretations that appropriate social response is made difficult81 71 70 Empathy may be a strength of ADHD-I rather than ADHD
Helpfulness 71 70 yes
caring yes 71
Good observation skills yes if interested
Focus and perspective yes if interested
Quick comprehension 69 82 71 , if interested
Curiosity 83 (constantly asking why) 84 71 70
Explorers, as such prepared to take risks yes 71
Diversity of interests 69 Frequently changing interests
Open-mindedness yes yes
Open approach to others yes Openness in ADHD only slightly increased overall, more in individuals with attention and inhibition problems, slightly decreased in individuals with increased delay discounting and atypical working memory / verbal fluency85
Enthusiastic, passionate 86 71
Creativity 69 ; also known as divergent thinking87 82 71 88 75 89 90 76 91
Creativity: original problem solving divergent thinking 92 71 88
are good at making connections 92 71
Being able to look at things from different perspectives 93 Also as a stressful extreme: too many aspects in the head at the same time, so that this confuses and stresses93; always having to look at all sides, to the point of complicating simple things83 yes
Creativity: Imaginative yes 71 88 76
Creativity: Imaginative yes 94 89
Aversion to monotonous tasks 92 ; 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 thinking95 yes
rambling, digressive 93 easily strays from the topic, becomes too detailed
Decision-making problems think about pros and cons until the discussion is over93; always having to consider all sides, to the point of being unable to make a decision83; too many aspects in the head at the same time, so that this confuses and stresses93 typical pattern, especially with ADHD-I subtype
Ambition yes 71
Perfectionism 69 often dysfunctional perfectionism sometimes extreme with ASD
Mobile, agile, flexible yes 94 71
Spontaneity yes 71 76 Impulsivity ADHD core symptom
Intuition yes yes
playful into old age yes 71
can do many things at the same time yes 71
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 interested) up to task switching problems96 Hyperfocus (when interested) is an ADHD symptom97; unmedicated people with ADHD spent more time studying than unmedicated people and less time playing computer and video games or playing with others, according to one study 9891
More intense perception 99 69 ; sensitivity to noise87; sensitivity to light87; sensitivity to smell87; sensitivity to touch87; sensitivity to pain100; emotional10199 102 69 99 103 ; films can be extremely emotionally involving96104 69 increased sensitivity; correlated with creativity105
Ability to structure other people yes 106
Constantly energized 96 Almost inexhaustible energy94
Aversion to small talk 107 yes ASS: strongly pronounced
Great relief when meeting people of the same kind Mensa e.V. Self-help groups 108
Communication with autistic traits Giftedness is said to have communication behavior that “takes a step towards Asperger’s”.109 ADHD and ASD have a greater genetic overlap and a comorbidity of up to 50%.
Visual-spatial thinking 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 a coincidence, the negative traits that also occur more frequently in giftedness and ADHD could provide an indication of the cause of these traits.

The following character traits are often named in specialist literature for highly creative people:

  • Difficult social behavior110111112
  • Socially harsh behavior110111 112
    • 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 of113
  • Repellent/rough/rough114111
  • High psychotic personality values115111
  • Stronger negative affects116111
  • Greater physiological stress116111
  • More self-oriented perfectionism116

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

  • More irrational beliefs116

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

  • Feeling of isolation, 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 the respective otherness 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

6.2. Non-matching traits of giftedness and ADHD

6.2.1. Specific traits of ADHD

The following traits of ADHD are not typically reported in gifted individuals.

  • Great tenacity / perseverance / persistence
    • For ADHD71117
      • Physical fitness and enjoyment of exercise76
  • Warm-hearted
  • Little resentful75
  • Hostility117
  • Willingness to take risks
  • Irresponsibility117
  • Limited affectivity117
    • 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.
  • Submissiveness117
  • Love of physical work
    • In our opinion symptomatic at best as a typical stress reduction reaction in ADHD
  • Need for harmony75
  • Sense for situation comedy76
  • Prickly charm76

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.

6.2.2. Specific traits of gifted people

The following traits of gifted people are not considered typical for ADHD.118119120121122

  • Conspicuous features in relation to learning and thinking

    • High level of detailed knowledge and very good understanding of interrelationships69
    • Unusually pronounced Vocabulary and linguistic expression69
    • Early reading
    • (Early) interest in books that are well above the age level
    • Preference for independent work, high goals
    • Intrinsic motivation style69

  • 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

6.3. 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.123 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).124
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,125, 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.

7. 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 anywhere. Being such an outsider 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 large city in northern Germany, who in 2016 sent away an academic suffering from severe ADHD-I, who was already successfully taking ADHD medication, after 35 minutes of questionnaire anamnesis with the words: “You can’t have ADHD-I. You have a doctorate and a degree. You have a doctorate and a degree 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.126

The feeling of being an outsider and not belonging can lead to reduced self-esteem Self-esteem can lead to reduced self-esteem.127
Reduced self-esteem causes psychological stress.128

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 when people with ADHD seek to “blame” themselves.128 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.129
See also: Mental saturation.

8. 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 only 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.130 In this respect, a high IQ can mask an existing ADHD11131
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.132 Therefore, any 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 impairments133 and one study even found a massively higher incidence of ADHD in gifted people134, most other studies came to the conclusion that high intelligence predicts less severe effects of ADHD in the future135, particularly due to significantly less impaired executive functions in some cases.136137138139

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.140 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 performance141

9. Indications of ADHD through 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. In this case, the person with ADHD must not have taken any medication.

If a new IQ test shows a significant increase in working memory while taking medication after the dosage has been adjusted by a doctor, this would be a strong indication of ADHD.

10. Further information on ADHD and giftedness:

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