Giftedness and ADHD
Giftedness is (actually) a technical term and refers to people with an IQ of 130 and above (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, by giftedness this article does not mean the narrow definition term, but rather people in general with an IQ that is well above the average of 100.
Significantly reduced intelligence is associated with an increased risk of ADHD. This applies not only to an IQ below 70, but also to an IQ of 70 to 85.1
Even though we know many highly gifted people who suffer from ADHD, our following presentation does not intend to equate ADHD and giftedness, nor to justify one with the other. However, while dealing with the topics of ADHD, giftedness and high sensitivity (according to Aron) or heightened sensitivity, we encountered so many parallels and points of contact that we could not help but wonder whether they might be helpful in the search for an explanation of ADHD.
- 1. ADHD more common in giftedness?
2. Intelligence and IQ in ADHD
- 2.1. Definition of intelligence
2.2. IQ measurements in ADHD
- 2.1.1. Questions about the IQ test procedures when comparing ADHD sufferers and non-afflicted persons
- 2.1.2. Conclusions for IQ test procedures when comparing ADHD sufferers and non-affected persons
- 2.3. Influence of ADHD subtype on IQ?
- 2.4. Influence of comorbidities on IQ measurement
- 2.5. Influence of learning ability on IQ
- 2.6. Common genes of A(H)S and IQ
- 2.7. Intelligence deviation as a relevant factor for ADHD?
- 2.8. Speculation: Do stress and increased sensitivity train intelligence?
- 3. Giftedness and mental disorders
- 4. Delayed cortex maturation in ADHD as in giftedness
- 5. Similar traits of gifted people and ADHD sufferers
- 6. Differential diagnosis required
- 7. Giftedness and coping skills
- 8. ADHD testing through intelligence testing?
- 9. More about ADHD and giftedness:
1. ADHD more common in giftedness?
Several sources claim that ADHD sufferers do not have a higher IQ than non-affected persons.2 Some report a slightly below average to normally distributed intelligence with 10% affected with an IQ of 1203, others report 5 to 6% highly gifted among ADHD sufferers4 in the range of verbal IQ, which would be clearly above average.
A recent study shows a massively above-average occurrence of ADHD symptoms in adults with an IQ of 130 and higher (37%) and in 7.7% of children with an IQ of 135 and higher, which is almost three times more frequent than in the control group (2.8%).5 A survey of the Baden-Württembergische Landesverband Hochbegabung e.V. in 2002 among 252 highly gifted members of the association between 5 and 30 years of age included 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. Limiting the survey to children with an IQ of 130 and above resulted in an ADHD rate of 6.6%.6 The result indicates an existing relationship, although the restriction to club members imposes a limitation on interpretability, since people who have no problems at all with an issue that affects them are generally less likely to have a reason to join a club. This study also reports many studies on IQ and ADHD that confirm a correlation.
These studies may be a reflection of increased ADHD rates in those with lowered IQs, making ADHD less likely in those with intermediate IQs.
One study determined an average IQ of 107.88 from 511 ADHD sufferers. Whether the subjects were tested with or without medication was (as is usually the case) not reported.7
In a lecture Barkley mentioned a reduced IQ of 7 to 10 IQ points in ADHD and justified this by the fact that the same genes as those for giftedness are involved.8 Another study also found decreased IQ scores in ADHD.9 In persistent ADHD the lowest IQ values were found, in late-onset ADHD the (relatively) highest. This study also did not differ according to medication status.
A fascinating similarity of giftedness and ADHD from a neurological perspective is reported by Eckerle.10
Even if a correlation between HB and ADHD should one day be proven, the overall conclusion, with the clear finding that ADHD and marked underachievement also correlate, should nevertheless only show that particularly high and particularly low IQs are equally associated with an increased risk of ADHD.
2. Intelligence and IQ in ADHD
2.1. Definition of intelligence
Intelligence is not a scientifically fixed measure, but a - quite differently - defined term.
According to Newton & McGrew’s definition, general intelligence includes eight broad components:11
- Fluid thinking (abstract thinking ability)
- Crystalline general knowledge
- Visuo-spatial ability
- Long-term memory
- Auditory processing
- Information processing speed
- Short-term memory
- Quantitative knowledge
as well as additional skills such as psychomotor skills.12
Gardner distinguishes eight independent intelligences in his “Theory of Multiple Intelligences” model:
- Spatial (which distinguishes architects, for example)
- Physical-kinesthetic (common among athletes and dancers)
- Natural history
- Interpersonal intelligence (facilitates work with fellow human beings)
- Intrapersonal (ability to self-reflect)
Common portions of working memory and short-term memory correlate with intelligence.13
The efficiency of working memory is a crucial factor for the measure of intelligence.
Highly gifted people thus automate their thinking performance. Highly gifted people do not simply think more than normally gifted people, but they use their brain more efficiently. The more efficient use occurs, among other things, by automating processes that normal gifted people bring about with active thinking (working through individual thinking steps in the frontal cortex) and outsourcing these automated thinking processes to the hindbrain cortex.14
Automation is not something that only highly gifted people can do.
Example: Learning to drive a car. The first attempts are exhausting: consciously coordinating all the levers, switches, the pedals and the steering wheel and, on top of that, paying attention to the traffic at the same time is tedious. After some time and practice, however, the brain has automated these processes and one operates the vehicle almost intuitively and can fully concentrate on the traffic. Some drivers who drive very little after the driving test do not reach this state of automation.
Anyone who has automated a process usually has considerable difficulties in teaching another person these automated processes (such as driving a car). To do this, the person must first become aware of the automated processes again with great effort.
So anyone can automate. Highly gifted people only 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 a thing very much and have reached an intuitive access to it say: “I see it”.
2.2. IQ measurements in ADHD
Among other things, working memory is impaired in ADHD sufferers. Intelligence tests usually also measure working memory.
Optimal treatment, be it successful neurofeedback or medication with stimulants, relieves the IQ reduced by ADHD symptoms (especially the massive impairment of working memory) of this burden - working memory impairment is reduced.
The ADHD burden on IQ can be as high as 20 IQ points in individual cases. On average, it could be around 10 IQ points.
“Stimulants can never improve intelligence as such, but in ADHD they make it available again for the affected person. Follow-up observations show that a drop in IQ of up to 15% can occur with no treatment, but that conversely an increase in IQ of the same magnitude can be expected with stimulant treatment.”1516
A Swedish placebo-controlled study found a mean IQ improvement of 4.5 points in children with ADHD aged 6-11 years after 9 months of treatment with amphetamine sulfate.17
Of 19 participants with ADHD-HI according to DSM III-R 12, 11 responded very well to neurofeedback training in which beta was trained up and theta was trained down (40 sessions). The other 7 showed smaller improvements. In the responders, IQ improved by 10 points at the same time as symptomatology (from 112 to 122).18 Other sources report a difference of 20 IQ points between acute and inapparent (medicated) symptom states.19
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 among the participating affected persons (22% of whom were unmedicated) and an IQ of 116 among the participating non-affected persons.20 Exclusion criterion for participation was an IQ below 80, so there is no significance about the overall IQ average of ADHD sufferers. The study can only serve as a reason to assume that the IQ average would have been more balanced if all affected test persons had received medication.
A study of n = 61,640 subjects found that scores on admission to higher educational institutions of medicated ADHD sufferers were significantly better (by 4.8 points out of a possible 200) than those of nonmedicated ADHD sufferers.21
A case of an increase of 30 IQ points after 3 years of ADHD therapy was reported in one forum.22
The statement “ADHD has nothing to do with giftedness”, in the sense of “giftedness and ADHD do not correlate with each other” or “the IQ of ADHD sufferers and non-affected persons is the same”, can therefore not be correct (in this global form), since ADHD obviously has an influence on examination and test results, which - like IQ tests - depend on the usable IQ.
An important question is:
Were the ADHD sufferers whose IQ was compared with that of non-affected persons tested with or without medication? Very few studies provide information about this, which already gives rise to considerable doubts about the reliability of conclusions about the IQ of the affected persons.
A. Were the ADHD patients tested with medication and were they optimally adjusted?
If the IQ of only medicated ADHD sufferers and the average of non-affected persons is the same, the IQ results of unmedicated ADHD sufferers should be significantly (approx. 10 IQ points) below the average of non-affected persons, because the impaired working memory (short-term memory) in unmedicated ADHD sufferers impairs IQ. 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 ADHD sufferers would be so unusual that this would have been reported.
B. Were the ADHD sufferers tested unmedicated?
Then the following possibilities arise:
The evaluations of the IQ tests were carried out by excluding the share of working memory. In this case, however, the statement “The IQ of ADHD patients and non-affected persons is the same” would be wrong and would have to be restricted with “if working memory is excluded”. So far, we have not found such a restriction anywhere.
Other brain areas of ADHD sufferers can compensate for the below-average working memory. However, then the other brain areas of ADHD sufferers would function better on average than those of non-affected persons. This would be nothing else than a partially higher aptitude, which (coincidentally?) is just as high that the IQ impairment is compensated by the burdened working memory.
This seems very unlikely. Moreover, such a result would be so surprising that it would have been the subject of reports with some probability.
C. Was no attention paid to medication?
Such tests would be useless due to the presented influence of the impaired working memory in ADHD on IQ.
Since the above alternatives to the influence of medication were not mentioned in most studies, we suspect this variant.
2.1.2. Conclusions for IQ test procedures when comparing ADHD sufferers and non-affected persons
For IQ tests of ADHD sufferers, we believe the following follows:
For a comparison of the IQ average of ADHD sufferers with that of non-affected persons:
- The IQ submeasurements for working memory must be evaluated separately.
- When comparing ADHD sufferers / non-affected persons, only optimally medicated persons may be tested for the IQ tests of ADHD sufferers (medically optimally adjusted medication and taking the medication during the test).
- Since medication can usually only alleviate ADHD symptoms, but not completely resolve them, even this would have limited effect on true comparability.
- It would at least be interesting to see whether the respective test results would change significantly if, for IQ matching of the subjects, IQ was matched once from unaffected to optimally medicated affected and once from unaffected to unmedicated affected.
For the treatment of ADHD sufferers:
- Successful treatment makes the intelligence that is actually present and impaired by ADHD symptoms (partially) available again.
Of 19 participants with ADHD-HI according to DSM III-R 12, 11 responded very well to neurofeedback training in which beta was trained up and theta was trained down (40 sessions). The other 7 showed smaller improvements. In the responders, IQ improved by 10 points (from 112 to 122) in addition to symptomatology.18
2.3. Influence of ADHD subtype on IQ?
According to a (single) study, the IQ of all ADHD patients was reduced by 15 points, and for ADHD-C the IQ was considerably lower than for the predominantly inattentive (ADHD-I) or the predominantly hyperactive/impulsive ADHD-HI subtype. Only for the predominantly hyperactive/impulsive ADHD-HI subtype was IQ comparable to the control group.23 However, even the abstract of the article contradicts the reported values.
Our impression does not coincide with this.
2.4. Influence of comorbidities on IQ measurement
Further, it should be noted that partial performance disorders often occur as comorbidities in ADHD, including:
- Reading and spelling disability (dyslexia)
Their effects may have an influence on the measurement results in the linguistic or mathematical area. This could result in a value in the measurement of the overall IQ that could be too low in view of the abilities for abstraction and analytical thinking.24
For a clean comparison of the IQ of ADHD sufferers with non-affected persons, such comorbidities would have to be excluded.
⇒ Partial Performance Disorders in the article Comorbidity
2.5. Influence of learning ability on IQ
Although IQ is fundamentally genetically predisposed, this disposition includes a mean deviation of 21 IQ points as a random dispersion measure. This can be eliminated with a suitably high number of subjects (n).
In contrast, what cannot be eliminated from IQ tests of ADHD sufferers is that IQ in school-aged children continues to be significantly
- From the social environment and
- From the ability to learn
Children adopted by socially advantaged parents from a socially disadvantaged family had only 17% of their children remain in school until the 6th grade 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….25 This experience is consistent with other findings in this regard.
ADHD sufferers symptomatically suffer from reduced attention and concentration abilities. It is plausible that children who are less able to learn for psychological reasons also suffer limitations in IQ development (independent of the genetic disposition to intelligence).
However, these facts cannot be easily reconciled with the statement that the IQ of ADHD sufferers does not differ from that of non-affected persons.
2.6. Common genes of A(H)S and IQ
One study reports more than 30 genes with a correlation between ADHD and IQ.26
2.7. Intelligence deviation as a relevant factor for ADHD?
The finding that the overall average IQ of ADHD sufferers is the same as that of non-affected individuals does not necessarily mean that intelligence may not be a significant influencing factor in relation to ADHD.
In the case of schizophrenia, it is known that normal gifted persons are affected less frequently, whereas highly gifted and less gifted persons are affected more frequently than average. The overall average of those affected may again correspond to the overall average (100) - yet IQ is a significant factor.
Schizophrenia is also highly dependent on dopamine levels. The positive symptoms result from a too high dopamine level, the negative symptoms from a too low dopamine level. The negative symptoms show certain parallels to ADHD symptoms.
It is conceivable that a greater deviation in IQ, both upward and downward, represents a stressor in its own right insofar as this “being different” makes it more difficult to belong to groups. That being an outsider can be a stressor is plausible. For this reason, a differential diagnosis to unrecognized giftedness is common in ADHD.
2.8. Speculation: Do stress and increased sensitivity train intelligence?
Rats growing up in “enriched environments” develop a thicker cortex. Derived from this, it would be conceivable that the increased sensitivity correlating with ADHD as well as with giftedness, which we perceive as corresponding to an “enriched perception”, leads to a thicker cortex (which at the same time develops later).
Enriched Environment, HEE, are housing conditions under increased social interaction and sensory and motor stimulation.28
Enriched Environments increase performance in various behavioral tests in rodents and recovery from central nervous system damage in rats and slows neurodegenerative aging processes.
The cause is thought to be increased neurotrophin expression (e.g., nerve growth factor, NGF) and associated increased neurogenesis in the hippocampus. Further, the stress-induced increase of 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.29
The effect of enriched environments seems to be age-dependent. It is true that positive effects are already evident in childhood. However, the greatest benefit was observed in middle adolescence. Enriched environments resulted in improved selective and auditory sustained attention, increased exploratory and food-gathering behavior, and a significant decrease in corticosterone levels and reduced anxiety levels.30
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 in adolescence can lead to a potentiation of stress in early childhood.31
Since it is known from giftedness research that IQ can change by 10 points within 10 years and, moreover, we seem to encounter the combination of stress sensitivity and special giftedness with unnatural frequency, we have developed the hypothesis that stress has its own mechanism of action that promotes IQ.
This may explain why the character traits attributed to ADHD sufferers as positive traits in the ADHD literature and the traits attributed to gifted individuals in the giftedness literature have such surprising similarities.
A correspondence to this hypothesis could result from the fact that mild stress leads to a slight increase of dopamine and norepinephrine 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 brain areas.
More frequent mild stress could thus 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 becomes highly gifted. And you don’t have to have exactly these genes or those genes to be highly gifted - at best, it increases the chance. People who have been given genes favorable for giftedness also need an (early childhood) environment that enables the manifestation, the actual formation of this genetic disposition.
Up to this point, the emergence of giftedness is no different from the emergence 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”. More accurately, it should be called chance-risk gene polymorphisms, because 99% of people’s genes are the same, but they all differ in various subtypes (polymorphisms). In the interest of readability, we have therefore shortened the expression somewhat.
We currently know 6 risk-reward genes. The most important are
- COMT: Met158Met
- DRD4: 7R
- 5HTTPR: short
We suspect that these gene variants are the basis for increased sensitivity and thus vulnerability. If carriers of these genes are particularly promoted, they develop better than other people. If carriers of these genes are neglected or mistreated, they develop worse than other people. Those affected are sometimes referred to (in a rather esoteric-sounding way) as orchid children.3233
Chance-risk genes could also be described as genes that respond particularly intensely to both positive and negative environmental influences. For a more detailed account of how chance-risk genes function and references on this topic, see ⇒ How ADHD develops: Genes + Environment. For an in-depth account of how COMT Met-158-Met influences dopamine balance in a way that results in higher mental performance and, at the same time, greater susceptibility to stress, see ⇒ The neurological cause of attention symptoms, section dopamine depletion in the PFC by COMT instead of by DAT
Just as a special support of carriers of chance-risk-genes often leads to special achievements like giftedness, neglect or maltreatment (which in its severity would not hurt people without these genes = resilience) leads to particularly adverse consequences in carriers of these genes - thus also to more frequent mental disorders.
Examples of this are ADHD and borderline.
Borderline correlates genetically significantly to the COMT Met158Met polymorphism, which is further amplified when the COMT Met158Met and 5-HTTPR-short allele gene polymorphisms coincide.34
That the coincidence of multiple opportunity-risk genes further increases sensitivity and vulnerability is plausible.
That the five times slower dopamine degradation in the PFC due to COMT Met158Met compared to COMT Val158Val basically leads to an increased mental performance as well as to an increased susceptibility to stress confirms the hypothesis of Andrea Brackmann, who perceived a conspicuously large number of at least partially highly gifted people among her borderline patients.35
Against this background, it no longer seems inconclusive to us that genes that have such intense effects on the psyche can cause typical character traits similar to those attributed to gifted individuals and ADHD sufferers.
3.2. Common environmental causes of intelligence and mental disorders
Newborn Brown Norway rats, known for their long and healthy lifespan, were separated from their mother for a single 24-hour period on day 3 of life. At 30 months of age, they differed significantly from the siblings remaining with the mother:
The learning ability in animals that had been separated from their mothers for 24 hours two and a half years earlier was either particularly good or particularly poor, but hardly average. Among their siblings not separated from the mother, on the other hand, the majority were mediocre learners and only some were good or poor learners (normal distribution).36
4. Delayed cortex maturation in ADHD as in giftedness
Highly gifted people differ from normal gifted people by a clearly delayed maturation of the cortex thickness. This delayed development of cortex thickness impressively coincides with that of ADHD sufferers.1037
The higher the giftedness, the later the first maximum of cortex thickness is reached. In highly gifted individuals, the first maximum of cortex thickness (approx. 4.85 mm) is reached at 11.1 years of age, in above-average (but not highly) gifted individuals (4.85 mm) at 9 years of age, and in average and weakly gifted individuals (4.75 mm) already at around 6 years of age. In ADHD sufferers, the peak of cortex thickness (4.85 mm) is reached at 10.5 years.
The thinner the cortex, the greater the symptoms of inattention in ADHD.38
Further research confirms that the reduced volume in various brain areas observed in children with ADHD does not persist in adulthood.39 This is consistent with the finding that only a later maturation of brain volume maxima occurs.
From the fact that the amount of norepinephrine metabolites (NE breakdown products) in urine normalizes in ADHD sufferers with and further after puberty, in parallel with the decrease of (child-typical) ADHD-HI symptoms, a brain maturation delay in ADHD is concluded.40
Such a “brain maturation delay” is also found more frequently than average in carriers of the DRD4 7 allele polymorphism.41 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 perceptions, although this is not covered by the current data we are aware of.
As a result, the described facts strengthen the assumption of neurological similarities between gifted and ADHD sufferers.
5. Similar traits of gifted people and ADHD sufferers
In addition to the unpleasant symptoms, the ADHD literature unanimously names a typical bouquet of positive (character) traits of ADHD sufferers.
It is now interesting that the specialist literature on gifted people also identifies special character traits in gifted people. These positive traits mentioned in the literature on ADHD on the one hand and giftedness on the other hand show a degree of correspondence that can no longer be explained by coincidence.
Unfortunately, this correspondence is rarely addressed in the literature.27.
We have therefore started to collect a detailed overview of the matching and differing traits including the respective sources. However, the statements about traits in ADHD as well as in giftedness are to a large extent based on the subjective impression of the authors. Not all traits have been investigated by studies.
An earlier working hypothesis of ours on this was that these character traits might not come from ADHD or giftedness itself, but might be caused by heightened sensitivity (as part of Aron’s construct of high sensitivity).
ADHD, in our impression, is almost always accompanied by increased sensitivity. ADHD includes a weakness of stimulus filtering,42 whereby stimulus filtering weakness is, according to our understanding, merely another name for increased sensitivity.
However, the hypothesis that giftedness also correlates with increased sensitivity (as part of Aron’s construct of high sensitivity) found no correspondence in the ADxS.org symptom test data (n = 2,000, as of July 2020).
One study reports a marked increase in self-awareness sensitivity in gifted individuals.43
A helpful summary on the positive character traits of ADHD with quite a few references can be found at ADHSpedia.44
5.1. Convergent traits of giftedness and ADHD
- Strong sense of justice
- Much compassion for others
- For ADHD45
- Good observation skills
- Sharpness and clarity
- Quick comprehension
- Are explorers, as such willing to take risks
- For ADHD45
- Diversity of interests
- For giftedness43
- Openly approaching others
- One study found only a very slight increase in openness in ADHD overall, with the increase more likely to occur in those with attention and inhibition problems and slightly decreased in those with increased delay discounting and atypical working memory/verbal fluency.59
- Enthusiastic, passionate
- Original problem solving
- Can make connections well
- Be able to look at things from different perspectives
- Aversion to monotonous tasks
- Prolix, digressive
- For giftedness66
- Easily digress from topic
- Become too detailed
- For giftedness66
- Decision problems
- For ADHD45
- For giftedness43
- Agile, nimble, flexible6745
- Playful until old age
- For ADHD45
- Can do many things at the same time
- For ADHD45
- Often pronounced love of animals and nature
- Often amazing knowledge / skills in areas of great interest
- Ability to hyperfocus (for special interest)
- More intense perception
- More intense feeling
- Intense emotions
- Constantly under power
- Aversion to small talk
- For giftedness79
- Great relief when meeting people of the same kind
- For giftedness: Mensa e.V.
- For ADHD: self-help groups
- For ADHD80
- Preference for solitary/retreat/individual activities
In highly gifted people, the literature also knows typical disadvantageous character traits. If one is not inclined to regard the coincidence of positive traits as a coincidence, the negative traits, which also occur in parallel in giftedness and ADHD, could give a clue to the cause of these traits.
Highly gifted people are said to have communication behaviors that “go one step toward Asperger’s.”81
For highly creative people, the following character traits are named as common in the literature:
- Difficult social behavior828384
- Socially harsh behaviour8283 84
- E.g. by expressing perceived motives of others, which are not perceived by others and may also not be conscious to the affected persons85
- High psychotic personality scores8783
- Stronger negative affects8883
- Greater physiological stress8883
- More self-oriented perfectionism88
The enumeration mentioned up to this point arouses strong associations to ADHD traits according to our impression. However, a match is at least questionable for:
- More irrational beliefs88
Conspicuousness for the social environment, which often coincide in ADHD and giftedness:
- Feeling of being isolated
- Highly gifted: emotionally but at age-typical level, intellectually very developed
- ADHD: emotional development delayed compared to intellectual development
- Constant critical questioning of authorities
- Very individualistic
- Tendency to want to determine situations alone
However, we consider these factors to be a consequence of being different in each case rather than a congruent cause.
Abnormalities in relation to work behavior and interests
- Strong immersion in specific problems (HB: specific interests, ADHD: hyperfocus)
- Perfectionist demands
- Boredom and even refusal to work on routine tasks
Conspicuousness in kindergarten and school
- Boredom (HB: even more common, ADHD when inactive)
- Disturbing 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 reported as typical in gifted individuals.
- Great toughness / endurance
- Little resentment49
- Risk appetite
- For ADHD78
- Intense emotions correlate with good memory, since what is experienced is better remembered in the presence of intense emotion; however, working memory is impaired in ADHD. We know nothing about impairments of long-term memory.
- Love for physical work
- In our opinion, symptomatic at best as a typical stress reduction reaction in ADHD
- Need for harmony49
- Sense of situation comedy50
- Prickly charm50
In ADHD, changes in the Big 5 personality traits are reported:
- Neuroticism (significantly elevated)
- Conscientiousness (significantly reduced)
- Compatibility (reduced)
- Extraversion (reduced)
- Openness to experience, on the other hand, has hardly changed.
5.2.2. Specific traits of gifted people
Abnormalities related to learning and thinking
Conspicuousness in kindergarten and school
- No interest in age-appropriate activities, or in the subject matter of the grade level
Salient features for the social environment
- Hardly any interest in age-typical activities
- Preference for verbal rather than physical confrontations
- Choice significantly older friends
5.3. No change of positive traits by ADHD medication
ADHD medications, especially methylphenidate, do not alter (positive) traits.
There is evidence that the personality profiles of ADHD sufferers change with long-term medication.94 However, the development under medication (methylphenidate) changed in the 81 % MPH responders in almost all measured dimensions away from the (unfavorable, associated with personality disorders) extremes towards the more balanced design (which is less associated with personality disorders).95
The changes consistently demonstrate a change in the direction away from a more unstable personality to a more stable one.
ADHD sufferers consistently report that they notice no change in their personality when given the appropriate dosage. The typical statement is that the medication makes them much more themselves. Other perceptions occur with overdose or when non-affected individuals take AD(HHD) medications.
Stimulants, however, dampen the limbic system. Stimulants can therefore be associated with impaired emotionality, especially in overdose. Barkley explained in a presentation,96 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, he said. This naturally reduces affect. An individually too high stimulant dosage, especially an overdose, can therefore lead to impaired emotional experience, which occurs in about 20% of patients treated with stimulants.
In this context, Barkley refers to the increasingly frequent use of combination medication (stimulants and atomoxetine or stimulants and guanfacine) for this reason, in order to accumulate the respective positive effects and to spread and thus reduce the side effects, which are usually located in different areas. Atomoxetine, unlike stimulants, does not affect the limbic system and therefore does not affect emotional sensation. Atomoxetine activates the ACC and frontal lobe, directly affecting executive functions. Stimulants improve attention cognition, executive functions, and working memory. They are less useful for improving emotion regulation.
6. Differential diagnosis required
The fact that a differential diagnosis for unrecognized giftedness is necessary when ADHD is suspected does not reveal any neuro(physio)logical or biological connection between ADHD and giftedness. The necessity of differential diagnostics results solely from the fact that unrecognized gifted people (especially with individually limited social abilities) often live an outsider’s existence just like ADHD sufferers and do not feel that they really belong anywhere. Such an outsider position can cause massive social stress. This stress can be misunderstood as ADHD symptoms, which should therefore be ruled out by means of differential diagnostics.
⇒ ADHD symptoms are stress symptoms
Typical forms of expression include:
- Being an outsider, sometimes trying to compensate with class clown or other roles
- The feeling of not belonging
- Self-esteem problems together with the resulting comorbidities from depression to social phobias
The hypothesis that highly gifted people might not have ADHD is definitely incorrect. We know a relevant number of highly and extremely gifted people who have a clear ADHD-HI or ADHD-I diagnosis.
Nevertheless, there are supposed specialists, such as a psychiatrist at an ADHD-HI center in a large 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 history (without any tests) with the words: “You cannot have ADHD-I. You have a doctorate and a degree and can live independently. You have a doctorate and a degree and can live as a self-employed person. You can’t do that with ADHD-I.” The problems of those affected read like a sample collection of ADHD-I symptoms.
In unrecognized gifted individuals (especially children), ADHD-like symptoms are attributed to problems with the social environment.97
In the case of unrecognized gifted individuals, underchallenge can lead to boredom and - depending on the predisposition - to dreaming oneself away into an inner world (ADHD-I confusability) or to disrupting lessons, e.g. in order to get attention (ADHD-HI confusability). In addition, (over-) adjustment phenomena can occur when the affected person places the “blame” on themselves.99 This, in turn, can result in them intentionally working slowly or making mistakes, and thus neither being recognized as highly gifted nor expressing their frustration to the outside world. A constant underchallenge and the resulting lack of motivation can lead to a complete refusal to perform.100
See also Psychic saturation.
7. Giftedness and coping skills
The specialist literature on giftedness agrees that gifted people have an above-average coping ability as a result of their special abilities. Coping are coping strategies to defuse or circumvent impairments or deficits (regardless of their nature or cause) through appropriate behavior. Coping strategies do not correct ADHD. Coping merely leads to the affected person being better able to cope with the symptoms or to better understand how to avoid situations in which he or she would suffer from the symptoms.101
Here, a distinction must be made between expression and consequences. While one study of ADHD sufferers with an IQ of 120 or more found no differences in ADHD severity except for slightly lower cognitive impairment102, another study concluded that high intelligence predicts less severe ADHD effects in the future if ADHD is present.103 Another study found an even massively more frequent occurrence of ADHD in highly gifted individuals.104
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 follows as under 1 (IQ tests and working memory in ADHD): If highly gifted people have better coping strategies, they should have a lower rate of (diagnosed) ADHD. If, however, despite their improved coping strategies (which should mask ADHD better), highly gifted individuals are still diagnosed with ADHD as often as non-highly gifted individuals, then highly gifted individuals (without their coping strategies) are as much more likely to have ADHD as they are to make up for it with coping strategies. The difference may not be all that great, because even good coping skills can at best make up for mild ADHD or mitigate the severity of ADHD effects. Nevertheless, the difference is there.
8. ADHD testing through intelligence testing?
It would be at least theoretically conceivable to determine the impairment caused by ADHD by appropriate intelligence tests.
Intelligence tests usually also measure working memory. For the ADHD differential diagnosis of (non-)existing giftedness, only IQ tests that separately output the working memory values are therefore suitable for determining the ADHD indication of impaired working memory. The affected person must not have taken any medication for this.
Repeating the IQ test while taking medication after dosage adjustment by a physician should show a significant difference in working memory in ADHD sufferers. This would be a strong indication for ADHD.
9. More about ADHD and giftedness:
- Other sources
- Intelligence test online (with naturally limited validity)
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als eine mögliche Verhaltensalternative: Brackmann (2007): Jenseits der Norm – hochbegabt und hoch sensibel, Seite 43 ↥ ↥
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