Abstract
Objective: To demonstrate that high IQ children and adolescents diagnosed with ADHD tend to suffer from executive function (EF) impairments that: a) can be identified with a combination of standardized measures and normed self-report data; and b) occur more frequently in this group than in the general population. Method: From charts of 117 children and adolescents aged 6 to 17 years with high IQ ( ≥ 120) who fully met DSM-IV diagnostic criteria for ADHD, data on 8 normed measures of executive function (EF) were extracted: IQ index scores for working memory and processing speed, a standardized measure of auditory verbal memory, and 5 clusters of the Brown ADD Scale, a normed, age-graded rating scale for ADHD-related executive function impairments in daily life. Significant impairment was computed for each individual relative to age-appropriate norms for each measure and comparisons were made to base-line rates in the general population. Results: Sixty-two percent of participants were significantly impaired on at least 5 of these 8 markers of EF. Chi-square comparisons of scores from these high IQ participants were significantly different (p < 0.001) from standardization norms for each of the eight EF measures. Conclusions: High IQ children and adolescents with ADHD, despite their cognitive strengths, tend to suffer from significant impairments of executive functions that can be assessed with these measures; incidence of these impairments is significantly greater than in the general population. These results are fully consistent with data on high IQ adults diagnosed with ADHD.
Highlights
In our clinical practice, often children and adolescents with IQ scores in and above the superior range are brought by their parents for evaluation and treatment of chronic impairments related to symptoms of ADHD
After approval from the Human Investigations Committee of Yale University, charts of all children and adolescents who came during a four year period for evaluation in either of two ADHD clinics, one private, another in a university medical center, were reviewed to select every patient aged 6 to 17 years diagnosed with DSM-IV ADHD, any type, who had high IQ as defined by WISC III/IV [36,37] or WAIS-III [38] index scores for Verbal Comprehension (VCI) and/or Perceptual Organization/Perceptual Reasoning (POI) ≥120
We determined how many of our 8 executive functions (EF) measures were impaired in each of these high IQ participants with ADHD
Summary
Often children and adolescents with IQ scores in and above the superior range are brought by their parents for evaluation and treatment of chronic impairments related to symptoms of ADHD. When the parents have inquired as to whether these difficulties of their offspring might be due to an attention deficit disorder, many have been told that such problems do not occur among individuals with such high levels of intellectual ability Parents of these very bright students report that their son or daughter has always been able to work very effectively on certain tasks in which they have strong personal interest. These students who demonstrate strong motivation and impressive cognitive strengths on those specific tasks that interest them tend to have much greater difficulty than most of their peers in trying to make themselves do homework, studying, and other important tasks that do not, for them, hold the same intense interest. When provided treatment appropriate for ADHD, these very bright students often show significant improvement in their ability to work effectively while their medication is active
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