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

Published online by Cambridge University Press:  24 December 2008

K. M. Antshel ,
S. V. Faraone ,
K. Maglione ,
A. Doyle ,
R. Fried ,
L. Seidman  and
J. Biederman
K. M. Antshel
Affiliation:
Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
S. V. Faraone*
Affiliation:
Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
K. Maglione
Affiliation:
Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA
A. Doyle
Affiliation:
Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
R. Fried
Affiliation:
Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
L. Seidman
Affiliation:
Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
J. Biederman
Affiliation:
Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
*
*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: [email protected])
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Abstract

Background

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.

Method

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.

Results

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.

Conclusions

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.

Keywords

ADHDimpairmentintelligentIQ
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 8 , August 2009 , pp. 1325 - 1335
Copyright
Copyright © 2008 Cambridge University Press

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References

Able, SL, Johnston, JA, Adler, LA, Swindle, RW (2007). Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychological Medicine 37, 97–107.CrossRefGoogle ScholarPubMed
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, 817–825.CrossRefGoogle ScholarPubMed
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, 687–694.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.Google Scholar
Babcock, Q, Byrne, T (2000). Student perceptions of methylphenidate abuse at a public liberal arts college. Journal of American College Health 49, 143–145.CrossRefGoogle Scholar
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, 592–599.CrossRefGoogle ScholarPubMed
Barkley, R, Murphy, K, Fischer, M (2007). ADHD in Adults: What the Science Says. Guilford Press: New York.Google Scholar
Barkley, RA (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin 121, 65–94.CrossRefGoogle ScholarPubMed
Barkley, RA (2002). Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry 63 (Suppl. 12), 10–15.Google ScholarPubMed
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, 192–202.CrossRefGoogle ScholarPubMed
Barrett, SP, Darredeau, C, Bordy, LE, Pihl, RO (2005). Characteristics of methylphenidate misuse in a university student sample. Canadian Journal of Psychiatry 50, 457–461.CrossRefGoogle Scholar
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, 872–874.CrossRefGoogle ScholarPubMed
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, 96–104.CrossRefGoogle Scholar
Biederman, J, Faraone, SV, Monuteaux, MC, Bober, M, Cadogen, E (2004). Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biological Psychiatry 55, 692–700.CrossRefGoogle Scholar
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, 1792–1798.Google ScholarPubMed
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, 1792–1798.Google ScholarPubMed
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, 524–540.CrossRefGoogle ScholarPubMed
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, 816–818.CrossRefGoogle ScholarPubMed
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, 1730–1738.CrossRefGoogle ScholarPubMed
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, 151–160.CrossRefGoogle ScholarPubMed
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, 1–14.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Academic Press: New York.Google Scholar
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, 370–379.CrossRefGoogle ScholarPubMed
Endicott, J, Nee, J, Harrison, W, Blumenthal, R (1993). Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacology Bulletin 29, 321–326.Google ScholarPubMed
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, 1081–1087.CrossRefGoogle ScholarPubMed
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, 159–165.CrossRefGoogle ScholarPubMed
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, 1720–1729.CrossRefGoogle ScholarPubMed
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, 9–20.CrossRefGoogle ScholarPubMed
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 33–34.CrossRefGoogle ScholarPubMed
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, 569–581.CrossRefGoogle ScholarPubMed
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, 186–206.CrossRefGoogle ScholarPubMed
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.Google Scholar
Frazier, TW, Demaree, HA, Youngstrom, EA (2004). Meta-analysis of intellectual and neuropsychological test performance in attention-deficit/hyperactivity disorder. Neuropsychology 18, 543–555.CrossRefGoogle ScholarPubMed
Gallagher, J, Harradine, CC (1997). Gifted students in the classroom. Roeper Review 19, 132–136.CrossRefGoogle Scholar
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, 316–321.CrossRefGoogle ScholarPubMed
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, 52–58.CrossRefGoogle ScholarPubMed
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, 465–475.CrossRefGoogle ScholarPubMed
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, 807–816.CrossRefGoogle ScholarPubMed
Harrison, AG, Edwards, MJ, Parker, KC (2007). Identifying students faking ADHD: preliminary findings and strategies for detection. Archives of Clinical Neuropsychology 22, 577–588.CrossRefGoogle ScholarPubMed
Hartnett, DN, Nelson, JM, Rinn, A (2004). Gifted or ADHD? The possibility of misdiagnosis. Roeper Review 26, 73–77.CrossRefGoogle Scholar
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, 958–965.CrossRefGoogle ScholarPubMed
Jastak, S, Wilkinson, G (1984). Manual for the Wide Range Achievement Test, revised edition. Jastak Associates: Wilmington, DE.Google Scholar
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, 716–723.CrossRefGoogle ScholarPubMed
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, 2606–2610.CrossRefGoogle ScholarPubMed
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, 879–883.CrossRefGoogle ScholarPubMed
Leroux, JA, Levitt-Perlman, M (2000). A gifted child with attention deficit disorder: an identification and intervention challenge. Roeper Review 22, 171–176.CrossRefGoogle Scholar
Lind, S, Silverman, L (1994). ADHD or gifted? Understanding Our Gifted 6, 13–16.Google Scholar
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.Google Scholar
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, 52–65.CrossRefGoogle ScholarPubMed
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, 143–169.CrossRefGoogle ScholarPubMed
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, 96–106.CrossRefGoogle ScholarPubMed
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, 1621–1627.CrossRefGoogle ScholarPubMed
Moran, P (1999). The epidemiology of antisocial personality disorder. Social Psychiatry and Psychiatric Epidemiology 34, 231–242.CrossRefGoogle ScholarPubMed
Mortensen, LH, Sorensen, TI, Gronbaek, M (2005). Intelligence in relation to later beverage preference and alcohol intake. Addiction 100, 1445–1452.CrossRefGoogle ScholarPubMed
Murphy, K, Barkley, RA (1996). Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Comprehensive Psychiatry 37, 393–401.CrossRefGoogle ScholarPubMed
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, 468–480.CrossRefGoogle ScholarPubMed
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.Google Scholar
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, 1020–1027.CrossRefGoogle ScholarPubMed
Robins, E, Guze, SB (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry 126, 983–987.CrossRefGoogle ScholarPubMed
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, 601–610.CrossRefGoogle ScholarPubMed
Sattler, J (2001). Assessment of Children: Cognitive Applications, 4th edn. Jerome M. Sattler: San Diego, CA.Google Scholar
Schechter, D, Endicott, J, Nee, J (2007). Quality of life of ‘normal’ controls: association with lifetime history of mental illness. Psychiatry Research 152, 45–54.CrossRefGoogle ScholarPubMed
Sullivan, BK, May, K, Galbally, L (2007). Symptom exaggeration by college adults in attention deficit hyperactivity disorder and learning disorder assessments. Applied Neuropsychology 14, 189–207.CrossRefGoogle ScholarPubMed
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, 253–262.CrossRefGoogle Scholar
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.Google Scholar
Webb, JT, Latimer, D (1993). ADHD and children who are gifted. Exceptional Children 60, 183–184.CrossRefGoogle Scholar
Wechsler, D (1993). Wechsler Adult Intelligence Scale, 3rd edn. Psychological Corporation: San Antonio, TX.Google Scholar
Weissman, MM, Bothwell, S (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry 33, 1111–1115.CrossRefGoogle ScholarPubMed
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, 460–466.CrossRefGoogle ScholarPubMed