High IQ May "Mask" the Diagnosis of ADHD by Compensating for Deficits in Executive Functions in Treatment-Naïve Adults With ADHD

J Atten Disord. 2017 Apr;21(6):455-464. doi: 10.1177/1087054714554933. Epub 2016 Jul 28.

Abstract

Objective: To evaluate and compare the performance of adults with ADHD with high and standard IQ in executive functions (EF) tasks.

Method: We investigated the neuropsychological performance of 51 adults with ADHD, compared with 33 healthy controls (HC) while performing a wide battery of neuropsychological tests that measure executive functioning. Adults with clinical diagnosis of ADHD were divided into two groups according to their IQ level (IQ ≥ 110-ADHD group with more elevated IQ, and IQ < 110-ADHD group with standard IQ).

Results: The ADHD group with standard IQ presented a worse executive functioning compared with the HC group in the following measures: Stroop 2 ( p = .000) and 3 ( p = .000), Trail Making Test (TMT) B ( p = .005), Wisconsin Card-Sorting Test (WCST)-perseverative errors ( p = .022) and failures to maintain set ( p = .020), Continuous Performance Test (CPT)-omission errors ( p = .005) and commission errors ( p = .000), and Frontal Assessment Battery (FAB)-conceptualization ( p = .016). The ADHD group with more elevated IQ presented only impairments in the CPT-commission errors ( p = .019) when compared with the control group.

Conclusion: Adults with ADHD and more elevated IQ show less evidence of executive functioning deficits compared with those with ADHD and standard IQ, suggesting that a higher degree of intellectual efficiency may compensate deficits in executive functions, leading to problems in establishing a precise clinical diagnosis.

Keywords: ADHD; IQ; executive functioning.

MeSH terms

  • Adult
  • Analysis of Variance
  • Attention Deficit Disorder with Hyperactivity / diagnosis*
  • Attention Deficit Disorder with Hyperactivity / psychology
  • Cognition / physiology
  • Executive Function / physiology*
  • Female
  • Humans
  • Inhibition, Psychological
  • Intelligence Tests
  • Intelligence*
  • Male
  • Neuropsychological Tests
  • Young Adult