"Healthy" stress reaction to stressful situation / reduced intelligence

Author: Ulrich Brennecke
Review: Dipl.-Psych. Waldemar Zdero

• 1. Acute subjectively threatening stress
  • 1.1. (Unrecognized) giftedness (> 120: 8.98 %; > 130: 2.28 %)
    • 1.1.1. Stress reaction of unrecognized gifted people as outsiders
    • 1.1.2. Similarities of individual typical traits in HB and ADHD
• 2. Intellectual disability (< 80: 8.98 %; < 70: 2.28 %)

1. Acute subjectively threatening stress¶

An acute and subjectively threatening stress situation can cause the entire ADHD symptomatology in otherwise healthy people.
All ADHD symptoms are stress symptoms. Therefore, all symptoms can be triggered by “normal” severe stress, i.e. by a situationally appropriate but strong perception of stress in healthy people.
When the stressful situation ends, the symptoms cease completely in healthy people.
However, if ADHD exists, the stress regulation system is permanently damaged due to genetic causes or a combination of a genetic disposition and too long, too intense (usually early childhood) stress exposure (⇒ Development of ADHD), so that the stress symptoms persist from then on even in the slightest (or no) stressful situations and the stress systems can overreact to minor stressful situations (ADHD-HI) or the stress systems ramp up and shut down again too early (ADHD-I).
⇒ ADHD as a chronic stress regulation disorder.
The first step in a differential diagnosis is therefore to determine whether acute circumstances exist that are so stressful that they can cause the symptoms, for example:

• Bullying¹
  • Depression
  • Fear
  • Shorter sleep
  • Insomnia
  • Poorer school grades
  • ADHD symptoms
• Separation from caregivers (divorce of parents)
• Separation problems with serious family conflicts²
• Death of a close relative
• Loss of the partner
• Subjectively unresolvable stressful situation (loss of control)
• Life change (for children: relocation, for adults: insolvency, contested divorce, etc.)
• Abusive parenting methods (e.g. ignoring the child; playing dead until the child obeys)
• Sexual abuse
• Physical abuse
• Etc.

1.1. (Unrecognized) giftedness (> 120: 8.98 %; > 130: 2.28 %)¶

Prevalence of giftedness: IQ 120 and above: 8.98%, IQ 130 and above: 2.28%

Giftedness is not a Disorder. Nevertheless, symptoms can arise from unrecognized giftedness that are almost identical in nature and composition to ADHD symptoms.

1.1.1. Stress reaction of unrecognized gifted people as outsiders¶

Gifted children have different interests, think “differently”, have different values and react differently. The lower the social skills with which people with ADHD can overcome their differences, the stranger other children find them. This can trigger negative reactions and even bullying. But even without bullying, the “feeling different” and “not belonging” (which is not only similar, but identical to people with ADHD) and the lack of friends can increase to such a massive level of stress that the stress symptoms typical of ADHD can develop.
People with ADHD are then fidgety, disrupt lessons, act out in class (ADHD-HI-like) or switch off internally and daydream (ADHD-I-like).
In addition to the possible stress symptoms of bullied outsiders (which may well include unrecognized gifted people due to their difference), however, there are other similarities between ADHD and giftedness that are not caused by stress.

1.1.2. Similarities of individual typical traits in HB and ADHD¶

Giftedness not only causes faster thinking, but often correlates with typical traits (“character traits”). Many of these traits are similar to characteristics that are often observed in people with ADHD.
⇒ Giftedness and ADHD

We had suspected that the impressive correspondence between the positive characteristics of ADHD described in the ADHD literature and the typical character traits of gifted people described in the gifted literature resulted from the fact that ADHD almost always correlates with giftedness and giftedness very often correlates with high sensitivity. We assumed that these are character traits that do not result from ADHD or giftedness itself, but that they have their actual root in the shared high sensitivity.
However, more recent data (also from the ADxS.org symptom test, n = 2000, as of July 2020) show no correlation between giftedness and high sensitivity.

Highly gifted people as well as people with ADHD are attributed from the respective specialist literature:

• Primarily intrinsically motivated (extrinsically difficult to motivate through external pressure)
  • Ability to hyperfocus
  • Boredom and concentration problems with uninteresting or monotonous tasks (up to underperformance and excessive error rate)
  • Impatience
  • Tendency to interrupt others
• Rejection of authority (authority is only recognized on the basis of competence, not rank)
• For some: difficulty in making decisions (too many options and facts to consider); mainly in people who internalize their stress reactions, less in people who externalize stress
• Smalltalk version
• Diplomacy deficit
• Aversion to crowds
• High importance of truth, equality, justice
• Often being perceived as weird or strange by others.

These traits (which of course do not occur in every case of HB, but are common in HBs) should therefore be examined closely for their cause during diagnosis.

Unrecognized giftedness is not easy to spot. Not all gifted people have special abilities. Many gifted people even emphatically reject such a classification for themselves because they do not perceive themselves in this way. It is important to note the difference between giftedness = disposition and ability = realization of giftedness. Many gifted people need suitable support in order to develop their abilities. In addition, not all giftedness lies in areas relevant to school. Numeracy geniuses or the variant of the gifted person with a thirst for knowledge are naturally easily recognized as gifted.³⁴⁵

Of course, being gifted is not a compelling reason for feeling like an outsider and/or for developing ADHD-like symptoms. It usually affects those who are unable to compensate for their otherness with sufficient social skills.
All the prevalence rates mentioned are merely a rough guide to make the probability of possible comorbidity visible. And, of course, not every child with ADHD is gifted.

2. Intellectual disability (< 80: 8.98 %; < 70: 2.28 %)¶

Intellectual disability (an IQ below 70) and learning disability (an IQ between 85 and 70) and their Consequences for learning-performance behavior and reactive behavioral disorders (when over/underchallenged) can act like ADHD. With an IQ ADHD occurs more frequently with intelligence reduction.⁵
Prevalence: IQ 80 and less: 8.98 %, IQ 70 and less: 2.28 %

In the case of an existing intellectual disability, the DSM-V criteria only appear to be suitable for ADHD diagnosis to a limited extent. In particular, the main symptoms of the DSM-V in cases of intellectual disability can also result from the intellectual disability itself. One study was only able to correctly diagnose 46% of people with ADHD with reduced intelligence using the DSM-V. Additional criteria - which the authors do not mention - are said to have increased the diagnostic accuracy of ADHD with intellectual disability to 82%.⁶

One study found that the Verbal Fluency Task showed lower phonological and semantic fluency in intelligence impairment than in people with ADHD and lower semantic fluency than in dyslexics.⁷