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Is adult attention deficit hyperactivity disorder a valid diagnosis in the presence of high IQ?

  • K. M. Antshel (a1), S. V. Faraone (a1), K. Maglione (a1), A. Doyle (a2), R. Fried (a2), L. Seidman (a2) and J. Biederman (a2)...



Because the diagnosis of attention deficit hyperactivity disorder (ADHD) in higher education settings is rapidly becoming a contentious issue, particularly among patients with high IQs, we sought to assess the validity of diagnosing ADHD in high-IQ adults and to further characterize the clinical features associated with their ADHD.


We operationalized high IQ as having a full-scale IQ⩾120. We identified 53 adults with a high IQ who did not have ADHD and 64 adults with a high IQ who met diagnostic criteria for ADHD. Groups did not differ on IQ, socio-economic status or gender.


High-IQ adults with ADHD reported a lower quality of life, had poorer familial and occupational functioning, and had more functional impairments, including more speeding tickets, accidents and arrests. Major depressive disorder, obsessive-compulsive disorder and generalized anxiety disorder diagnoses were higher in high-IQ adults with ADHD. All other psychiatric co-morbidities, including antisocial personality disorder and substance abuse, did not differ between the two high-IQ groups. ADHD was more prevalent in first-degree relatives of adults with ADHD relative to controls.


Our data suggest that adults with ADHD and a high IQ display patterns of functional impairments, familiality and psychiatric co-morbidities that parallel those found in the average-IQ adult ADHD population.


Corresponding author

*Address for correspondence: S. V. Faraone, Ph.D., Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA. (Email:


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Able, SL, Johnston, JA, Adler, LA, Swindle, RW (2007). Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychological Medicine 37, 97107.
Antshel, KM, Faraone, SV, Maglione, K, Doyle, A, Fried, R, Seidman, L, Biederman, J (2008). Temporal stability of ADHD in the high-IQ population: results from the MGH Longitudinal Family Studies of ADHD. Journal of the American Academy of Child and Adolescent Psychiatry 47, 817825.
Antshel, KM, Faraone, SV, Stallone, K, Nave, A, Kaufmann, FA, Doyle, A, Fried, R, Seidman, L, Biederman, J (2007). Is attention deficit hyperactivity disorder a valid diagnosis in the presence of high IQ? Results from the MGH Longitudinal Family Studies of ADHD. Journal of Child Psychology and Psychiatry 48, 687694.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.
Babcock, Q, Byrne, T (2000). Student perceptions of methylphenidate abuse at a public liberal arts college. Journal of American College Health 49, 143145.
Barker, ED, Seguin, JR, White, HR, Bates, ME, Lacourse, E, Carbonneau, R, Tremblay, RE (2007). Developmental trajectories of male physical violence and theft: relations to neurocognitive performance. Archives of General Psychiatry 64, 592599.
Barkley, R, Murphy, K, Fischer, M (2007). ADHD in Adults: What the Science Says. Guilford Press: New York.
Barkley, RA (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin 121, 6594.
Barkley, RA (2002). Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry 63 (Suppl. 12), 1015.
Barkley, RA, Fischer, M, Smallish, L, Fletcher, K (2006). Young adult outcome of hyperactive children: adaptive functioning in major life activities. Journal of the American Academy of Child and Adolescent Psychiatry 45, 192202.
Barrett, SP, Darredeau, C, Bordy, LE, Pihl, RO (2005). Characteristics of methylphenidate misuse in a university student sample. Canadian Journal of Psychiatry 50, 457461.
Batty, GD, Deary, IJ, Macintyre, S (2006). Childhood IQ and life course socioeconomic position in relation to alcohol-induced hangovers in adulthood: the Aberdeen children of the 1950s study. Journal of Epidemiology and Community Health 60, 872874.
Baum, SM, Olenchak, FR, Owens, SV (1998). Gifted students with attention deficits: fact and/or fiction? Or, can we see the forest through the trees? Gifted Child Quarterly 42, 96104.
Biederman, J, Faraone, SV, Monuteaux, MC, Bober, M, Cadogen, E (2004). Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biological Psychiatry 55, 692700.
Biederman, J, Faraone, SV, Spencer, T, Wilens, T, Norman, D, Lapey, KA, Mick, E, Lehman, BK, Doyle, A (1993 a). Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry 150, 17921798.
Biederman, J, Faraone, SV, Spencer, T, Wilens, T, Norman, D, Lapey, KA, Mick, E, Lehman, BK, Doyle, A (1993 b). Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry 150, 17921798.
Biederman, J, Faraone, SV, Spencer, TJ, Mick, E, Monuteaux, MC, Aleardi, M (2006 a). Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. Journal of Clinical Psychiatry 67, 524540.
Biederman, J, Mick, E, Faraone, SV (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American Journal of Psychiatry 157, 816818.
Biederman, J, Petty, C, Fried, R, Fontanella, J, Doyle, AE, Seidman, LJ, Faraone, SV (2006 b). Impact of psychometrically defined deficits of executive functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry 163, 17301738.
Bishop, S, Walling, D, Dott, S, Folkes, C, Bucy, J (1999). Refining quality of life: validating a multidimensional factor measure in the severe mentally ill. Quality of Life Research 8, 151160.
Bridgett, D, Walker, M (2006). Intellectual functioning in adults with ADHD: a meta-analytic examination of full-scale IQ differences between adults with and without ADHD. Psychological Assessment 18, 114.
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Academic Press: New York.
DuPaul, GJ, Schaughency, EA, Weyandt, LL, Tripp, G, Kiesner, J, Ota, K, Stanish, H (2001). Self-report of ADHD symptoms in university students: cross-gender and cross-national prevalence. Journal of Learning Disabilities 34, 370379.
Endicott, J, Nee, J, Harrison, W, Blumenthal, R (1993). Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacology Bulletin 29, 321326.
Faraone, SV, Biederman, J, Doyle, A, Murray, K, Petty, C, Adamson, JJ, Seidman, L (2006 a). Neuropsychological studies of late onset and subthreshold diagnoses of adult attention-deficit/hyperactivity disorder. Biological Psychiatry 60, 10811087.
Faraone, SV, Biederman, J, Mick, E (2006 b). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine 36, 159165.
Faraone, SV, Biederman, J, Spencer, T, Mick, E, Murray, K, Petty, C, Adamson, JJ, Monuteaux, MC (2006 c). Diagnosing adult attention deficit hyperactivity disorder: are late onset and subthreshold diagnoses valid? American Journal of Psychiatry 163, 17201729.
Faraone, SV, Biederman, J, Spencer, T, Wilens, T, Seidman, LJ, Mick, E, Doyle, AE (2000). Attention-deficit/hyperactivity disorder in adults: an overview. Biological Psychiatry 48, 920.
Faraone, SV, Wilens, TE, Petty, C, Antshel, K, Spencer, T, Biederman, J (2007). Substance use among ADHD adults: implications of late onset and subthreshold diagnoses. American Journal on Addictions 16 (Suppl. 1), 24–32, quiz 3334.
Finn, PR, Hall, J (2004). Cognitive ability and risk for alcoholism: short-term memory capacity and intelligence moderate personality risk for alcohol problems. Journal of Abnormal Psychology 113, 569581.
Finn, PR, Mazas, CA, Justus, AN, Steinmetz, J (2002). Early-onset alcoholism with conduct disorder: go/no-go learning deficits, working memory capacity, and personality. Alcohol: Clinical and Experimental Research 26, 186206.
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1997). Structured Clinical Interview for DSM-IV – Clinical Version (SCID-CV) (User's Guide and Interview). American Psychiatric Press: Washington, DC.
Frazier, TW, Demaree, HA, Youngstrom, EA (2004). Meta-analysis of intellectual and neuropsychological test performance in attention-deficit/hyperactivity disorder. Neuropsychology 18, 543555.
Gallagher, J, Harradine, CC (1997). Gifted students in the classroom. Roeper Review 19, 132136.
Geller, D, Petty, C, Vivas, F, Johnson, J, Pauls, D, Biederman, J (2007). Examining the relationship between obsessive-compulsive disorder and attention-deficit/hyperactivity disorder in children and adolescents: a familial risk analysis. Biological Psychiatry 61, 316321.
Geller, DA, Biederman, J, Faraone, SV, Cradock, K, Hagermoser, L, Zaman, N, Frazier, JA, Coffey, BJ, Spencer, TJ (2002). Attention-deficit/hyperactivity disorder in children and adolescents with obsessive-compulsive disorder: fact or artifact? Journal of the American Academy of Child and Adolescent Psychiatry 41, 5258.
Gordon, M, Antshel, K, Faraone, S, Barkley, R, Lewandowski, L, Hudziak, JJ, Biederman, J, Cunningham, C (2006). Symptoms versus impairment: the case for respecting DSM-IV's criterion D. Journal of Attention Disorders 9, 465475.
Grant, BF, Stinson, FS, Dawson, DA, Chou, SP, Dufour, MC, Compton, W, Pickering, RP, Kaplan, K (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, 807816.
Harrison, AG, Edwards, MJ, Parker, KC (2007). Identifying students faking ADHD: preliminary findings and strategies for detection. Archives of Clinical Neuropsychology 22, 577588.
Hartnett, DN, Nelson, JM, Rinn, A (2004). Gifted or ADHD? The possibility of misdiagnosis. Roeper Review 26, 7377.
Hawi, Z, Segurado, R, Conroy, J, Sheehan, K, Lowe, N, Kirley, A, Shields, D, Fitzgerald, M, Gallagher, L, Gill, M (2005). Preferential transmission of paternal alleles at risk genes in attention-deficit/hyperactivity disorder. American Journal of Human Genetics 77, 958965.
Jastak, S, Wilkinson, G (1984). Manual for the Wide Range Achievement Test, revised edition. Jastak Associates: Wilmington, DE.
Kessler, RC, Adler, L, Barkley, R, Biederman, J, Conners, CK, Demler, O, Faraone, SV, Greenhill, LL, Howes, MJ, Secnik, K, Spencer, T, Ustun, TB, Walters, EE, Zaslavsky, AM (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163, 716723.
Lasser, K, Boyd, JW, Woolhandler, S, Himmelstein, DU, McCormick, D, Bor, DH (2000). Smoking and mental illness: a population-based prevalence study. Journal of the American Medical Association 284, 26062610.
Leckman, JF, Sholomskas, D, Thompson, WD, Belanger, A, Weissman, MM (1982). Best estimate of lifetime psychiatric diagnosis: a methodological study. Archives of General Psychiatry 39, 879883.
Leroux, JA, Levitt-Perlman, M (2000). A gifted child with attention deficit disorder: an identification and intervention challenge. Roeper Review 22, 171176.
Lind, S, Silverman, L (1994). ADHD or gifted? Understanding Our Gifted 6, 1316.
Lovecky, DV, Silverman, LK (1998). Gifted Children with AD/HD. Panel of the NIH Consensus Development Conference on Diagnosis and Treatment of Attention Deficit/Hyperactivity Disorder, Bethesda, MD.
Mahone, EM, Hagelthorn, KM, Cutting, LE, Schuerholz, LJ, Pelletier, SF, Rawlins, C, Singer, HS, Denckla, MB (2002). Effects of IQ on executive function measures in children with ADHD. Child Neuropsychology 8, 5265.
Masten, AS, Hubbard, JJ, Gest, SD, Tellegen, A, Garmezy, N, Ramirez, M (1999). Competence in the context of adversity: pathways to resilience and maladaptation from childhood to late adolescence. Development and Psychopathology 11, 143169.
McCabe, SE, Knight, JR, Teter, CJ, Wechsler, H (2005). Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction 100, 96106.
McGough, JJ, Smalley, SL, McCracken, JT, Yang, M, Del'Homme, M, Lynn, DE, Loo, S (2005). Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. American Journal of Psychiatry 162, 16211627.
Moran, P (1999). The epidemiology of antisocial personality disorder. Social Psychiatry and Psychiatric Epidemiology 34, 231242.
Mortensen, LH, Sorensen, TI, Gronbaek, M (2005). Intelligence in relation to later beverage preference and alcohol intake. Addiction 100, 14451452.
Murphy, K, Barkley, RA (1996). Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Comprehensive Psychiatry 37, 393401.
Nigg, JT, Hinshaw, SP, Carte, ET, Treuting, JJ (1998). Neuropsychological correlates of childhood attention-deficit/hyperactivity disorder: explainable by comorbid disruptive behavior or reading problems? Journal of Abnormal Psychology 107, 468480.
Orvaschel, H (1994). Schedule for Affective Disorders and Schizophrenia for School-Aged Children – Epidemiologic Version 5 (K-SADS-E). Nova Southeastern University: Ft Lauderdale, FL.
Poon, E, Ellis, DA, Fitzgerald, HE, Zucker, RA (2000). Intellectual, cognitive, and academic performance among sons of alcoholics, during the early school years: differences related to subtypes of familial alcoholism. Alcohol: Clinical and Experimental Research 24, 10201027.
Robins, E, Guze, SB (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry 126, 983987.
Satterfield, JH, Faller, KJ, Crinella, FM, Schell, AM, Swanson, JM, Homer, LD (2007). A 30-year prospective follow-up study of hyperactive boys with conduct problems: adult criminality. Journal of the American Academy of Child and Adolescent Psychiatry 46, 601610.
Sattler, J (2001). Assessment of Children: Cognitive Applications, 4th edn. Jerome M. Sattler: San Diego, CA.
Schechter, D, Endicott, J, Nee, J (2007). Quality of life of ‘normal’ controls: association with lifetime history of mental illness. Psychiatry Research 152, 4554.
Sullivan, BK, May, K, Galbally, L (2007). Symptom exaggeration by college adults in attention deficit hyperactivity disorder and learning disorder assessments. Applied Neuropsychology 14, 189207.
Teter, CJ, McCabe, SE, Cranford, JA, Boyd, CJ, Guthrie, SK (2005). Prevalence and motives for illicit use of prescription stimulants in an undergraduate student sample. Journal of American College Health 53, 253262.
Webb, JT, Amend, ER, Webb, NE, Goerss, J, Beljan, P, Olenchak, FR (2005). Misdiagnosis and Dual Diagnosis of Gifted Children and Adults: ADHD, Bipolar, Asperger's, Depression, and Other Disorders. Gifted Potential Press: Scottsdale, AZ.
Webb, JT, Latimer, D (1993). ADHD and children who are gifted. Exceptional Children 60, 183184.
Wechsler, D (1993). Wechsler Adult Intelligence Scale, 3rd edn. Psychological Corporation: San Antonio, TX.
Weissman, MM, Bothwell, S (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry 33, 11111115.
Weissman, MM, Olfson, M, Gameroff, MJ, Feder, A, Fuentes, M (2001). A comparison of three scales for assessing social functioning in primary care. American Journal of Psychiatry 158, 460466.


Is adult attention deficit hyperactivity disorder a valid diagnosis in the presence of high IQ?

  • K. M. Antshel (a1), S. V. Faraone (a1), K. Maglione (a1), A. Doyle (a2), R. Fried (a2), L. Seidman (a2) and J. Biederman (a2)...


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