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Intelligence & ADD/ADHD: Breaking The Myths

April 16th, 2012 by Maximilian M. Bolejko | Posted in Disorders and Pathologies | No Comments » | 692 views | Send article | Print this Article |


There are a lot of ideas flying around where most of the typical layman’s knowledge of ADD/ADHD usually asserts that the condition is not in fact a real mental health issue, or that it is the cause of poor schooling or poor parenting. The opinion that children with ADHD are of poor intelligence due to a perceived inability to focus on a given task is quite a commonality. It is not then difficult to imagine that parents who have been told their son or daughter was very bright, but was doing poorly in school due to inconsistencies or poor focus, have great difficulty acknowledging the fact that their child might have an attention deficit disorder. In fact, many parents have been told that such problems do not occur amongst individuals with higher levels of intellectual ability. Yet studies have shown that individuals with ADD/ADHD demonstrate the same cognitive problems in all ranges of IQ, even well above the 120 range.[1]

ADHD stands for Attention Deficit Hyperactivity Disorder and is a real mental health condition with strong scientific evidence pointing towards an inherited genetic basis with significant neurological abnormalities in the brain. Hence, in order to fully diagnose an individual for ADHD a neurological exam is required. Medication treatment studies were first to show persuasive evidence of ADHD impairment being the cause of two primary neurotransmitters not functioning properly. These are norepinephrine and dopamine. Several genes determining low dopamine levels (named DRD4, DAT1, etc.) have also been found to be associated with ADHD.[2] Another important factor in the condition was recently discovered in a study by the renomed ADHD specialist Prof. Russell Barkley and colleagues at the Medical University of South Carolina. The finding had to do with the decreased levels of GABA (gamma amino butyric acid) found in ADHD children. These low levels of which is yet another neurotransmitter, were found to explain the deficient impulse control and constant interchanging thoughts associated with the condition.[3] In other words, in order for the brain to stop an action, in this case a thought, it has to use the brains inhibitory neurons, this in order to prevent the ongoing surge of excitatory neurons from firing and generating new thoughts. Blocking excitatory neurons is precisely the task of GABA. This is a process that requires much more effort for the brain, equivalent to the increased effort for individuals with ADHD to get themselves to actually relax. A factor intertwined with dysfunctional dopamine circuits in ADHD is “proneness to boredom” which is a major fact in the condition and other hyperactivity/impulsivity-related conditions. It is often not comprehensible of just how painful the experience of boredom can be to people who do not have their brains wired in this way. Reduced GABA and dopamine levels might also explain the phenomenon of instable sleep patterns in individuals with ADHD, often times, as understood from individual reports, these individuals find themselves having to completely wear themselves out before a relaxed state becomes a possible. Of course we could just as well apply the finding of decreased GABA levels and their effects on more general terms as Prof. Daniela Cavetti states in a publication of the Journal of Cerebral Blood Flow & Metabolism.[4]

Maybe this explains why it is so tiring to relax and think about nothing.[5] Daniela Cavetti.

ADD is quite similar to ADHD, with the difference being that it refers to the condition often without the full-blown factor of hyperactivity. Although not always, many children learn to hide their impulsive tendencies from the surroundings, whilst growing up. This is often caused by the social pressures of behavior deemed normative and acceptable which in term might lead to elevated anxiety levels and a feeling of inner chaos described by many ADD individuals. However uncertain the precise cut-off point between ADHD and ADD, both groups have very similar problems stemming from many of the same neurological prerequisites.

In some cases it is not always clear that an individual has ADHD, even more so as regards to ADD, since it is not always easily inferred from behavior. Many individuals with ADHD/ADD actually tend have a very narrow set of behavioral problems. Most problems seem to occur when the environment is unable to properly support and recognize the condition early on. The causal factor is strong in a number of experimental studies asserting that ADHD is, in some cases, associated with the development of antisocial tendencies (ASPD) including various forms of malignant narcissism (NPD) that could be clinically corroborated. Just like everyone else, people with ADHD have goals and wishes which at times become unattainable due to environmental pressures often combined with the lack of social support. Many individuals with symptoms of the condition often do not become diagnosed until late adolescence or in some cases, never at all. Clinical interviews, especially concerting individuals with high IQ and ADHD seems to indicate that diagnosis is often obdurately delayed due to decreased recognition, labeling individuals as simply “lazy”. The noticeable variability of their ADHD symptoms and how they manifest themselves creates great uncertainties as to the current state of affairs regarding the individuals mental health and a diagnosis of ADHD. Symptoms might be present for extensive periods and yet still be confused with “laziness’” or “stupidity” where the individual might actually start feeling guilty and ashamed about themselves. This is, amongst many other factors, one of the reasons to continue to research ADHD and inform the general public in order to raise awareness of the condition.

As extracted from individual reports, ADHD individuals often describe feelings of “being aloof”, “feeling like an alien”, “feelings of not quite fitting in”. ADHD individuals often respond to their defense, for instance, when blamed for being lazy as described in Brown’s et al. (2005) studies, “I always work best under pressure“ or “I am just a severe procrastinator“.

A commonly voiced opinion is that ADHD is simply due to a lack of willpower and that individuals with ADHD should simply put more effort into what there doing at the time. Before drawing drastic conclusions it is important to note that individuals with the condition have reportedly been found to demonstrate great ability in performing tasks that are of specific personal interest. Whilst the view of ADHD individuals being lazy and simply lacking willpower seems rather reasonable, scientists are only recently discovering the inequality of this statement. This entails understanding the complexity of the condition that involves several regions of the brain including cognitive impairment, mainly in regions concerning Executive Functioning (EF). These are the areas managing such matters as organization, prioritizing, sustainment of effort, monitoring and regulating one’s actions. EF is also responsible for dealing with information regarding working memory and short-term visual memory, as well as the modulation and management of emotion.[6]

We could ask ourselves, is it justifiable to subscribe to the fact, as many seem to do, that the condition would be intellectually disabling to the affected individual? The origin of the research on ADHD was not very scientific until 1970 and onwards. ADHD children and adults were many times treated as the “bad seeds” of society who did nothing but reek havoc and got themselves into trouble. For a long period of time, ADHD was also considered a rather curable condition only applicable to children, and that with age, it was deemed something one could grow out of. As early as 1905 there were already writings on the topic of attentional deficit in the psychological literature, starting the surge of misinformation. These misconceptions might help explain the misleading fact of labeling an individual as having an attention deficit, in other words unable to hold one’s attention. Today, psychiatrists Dr Russell Barkley, PhD working at The Centre for ADHD/ADD Advocacy in Canada talks about precisely this fact, the miss naming of the condition referring mainly to the factor of inattention. In his claims he states that it is not so much about inattention than it is about motivation. The term of so called “hyperfocus”   has been coined in many articles about ADHD referring to the ability to focus for astonishingly extensive periods of time on events or fields of interest for the ADHD individual. It is not uncommon to find ADHD patients to be extremely bright, employed in various high positions in mentally challenging fields of science, business and law. Others have devoted their time and effort, often pushing themselves for hours to paint an artwork or to learn a new piece of music. Individual IQ actually appear to have little to do with one’s capabilities and whether or not the individual meets the criteria for ADD/ADHD. The factor of disorganization is hence completely independent of general intelligence. As it turns out, results by Sharon L. Thompson-Schill found that kids with superior intelligence (well above 120) had greater delay in maturation in their prefrontal cortices than regular IQ age-matched peers. Amongst many things the prefrontal cortex has been found to be responsible for such things as planning, paying attention and the regulation of processing speed. The research of Schill seem to propose that a delay of prefrontal cortex development fosters a more flexible and broad way of thinking in our early life experiences. This includes explosive learning curves with a wide general base of knowledge. As the cortex then starts to develop further one could imagine that this knowledge base is then complemented, resulting in a wide variety of general knowledge and schemes for how different things function. It might as well be that the underdeveloped powers of attention keep ADHD children from getting tied down to specific rules, e.g. that of grammar or other syntax with an application of often more general rules in vast number of different areas. For instance, learning that adding an “s” makes words plural rather than learning more specific rules of grammar as regards to the plural form.[7]

The main gist of ADHD, as already mentioned before, is the difficulty to deploy and sustain attention as ruled by the executive functions. Described as “totally spaced out“, a man of 43 years of age was able to start several tasks following one another whilst forgetting about the main task at hand. It was not until long after that he realized what the original task was all about. For most people, executive functions are automatic and are deployed without much effort. The problem for this man, who had been diagnosed with ADD, was not that he was not thinking enough about what he is doing at the time. The problem is one that is rooted in the cognitive mechanisms that were supposed to help him stay on the task. The phenomenon of constantly weighing alternatives and moving on to other tasks would not be apparent if these mechanisms were to function properly. This seems to infer that ADHD is not at all about willpower but about self-awareness and insufficient amounts of it in everyday life. ADHD is also not a condition that simply goes away in adulthood. ADHD it is a chronic ongoing condition operating from birth. Individuals with the condition have also found to be six times more likely to develop another psychiatric disorder than most other people, due to the risks of being much more genetically susceptible to negative environmental conditions.

Although many individuals do learn to deal with their symptoms, in some cases quite well, medication have found to be helpful in raising awareness and in the enhancement of concentration. Medication used for ADHD is among the best researched for any neurological disorder found today. However, research has shown that medication is not the only option for treating ADHD. A multimodal treatment study of ADHD showed that the most effective treatment strategy was an overall combination of medication and psychosocial treatment involving social skills and/or anger management training. Research have also shown that ADHD can be positively modified in terms of behavior and adapting new skills to better organize and reduce the symptoms of the condition by implementing ongoing treatment plans. Most of the medication is directed to control the dopamine deficit, addressing associated symptoms such as possible depression, anxiety, aggression and addiction to stimulant substances (e.g. alcohol, tobacco).

Ritalin is one of the most common medications prescribed for ADHD and has shown to be most effective. Research has demonstrated that as much as 80% of  children would perform better in school while taking the substance as opposed to other stimulant medication. Yet, like with all medication, side effects do occur. Some of the common side effects include insomnia, appetite suppression and the occurrence of extremely focused states. Experience of stomachaches and headaches may come about when medications effects wear of. Mild suppression of growth has also been found to be a risk factor in young children. This is usually dealt with having specific “medication periods“ with no medication during summer or, usually when not attending school. Reports of extremely flat affect (Dysphoria) are rare, but may occur as well as psychotic behavior such as delusions or hallucinations. This is usually a sign of the medication dosage being too high. Dehydration in combination with exercise or warm temperature may also be a serious risk that has to be taken into consideration.

However precarious the matter of medicating ADHD, it has been found to significantly reduce risk of  adults and adolescents with the condition to become involved with substance abuse in trying to manage their ADHD. However, overall research do point towards overwhelmingly strong evidence of a positive improvement of ADHD individuals lives when on medication. Most patients who take their medication consistently show positive outcomes in terms of  managing possible side effects and medication dosages. There are also some individuals who respond well to lower dosages of medication. Unfortunately, many fears of today’s dread for medication are due to media often highlighting cases of individuals abusing these types of medications. And in doing so, often providing negative information and faulty statistics regarding medication side effects.[8]

When ADHD is not treated with medication or therapy or understanding surroundings the trait characteristics of often very gifted ADHD people goes unnoticed. High intelligence amongst ADHD adults have showed to often bee frustrating, depressing and sometimes debilitating. Racing thoughts with continual deep thoughts combined with constant distractions and an inability to prioritize often leads to those late night cramming sessions for students.

As far as genetics are concerned, scientists argue that the frontal area is what is most involved regarding ADHD. Family studies made by Dr. Joseph Biederman (1990) have shown that ADHD runs in families, and that over 25% of the first-degree relatives of the families of ADHD children also had symptoms of ADHD. This is just one of the many findings pointing towards a strong genetical basis for ADHD. It is estimated that about 70% of children with ADHD have at least one parent who also have the disorder. One could imagine that this might also be one of the factors needing to be addressed the most, in that organization in the home environment might become stifled. In such instances, an examination if the parent has ADHD as well might be helpful. Yet, usually there is a parent available who does not posses ADHD traits and stands for the more organizational tasks of the home. In some cases, family therapy may be an option to help finding a balance in parenting style towards the child. Parents may often argue amongst themselves in being “too strict“ or “too permissive“ in dealing with the child. This may in term evoke various emotions and an upsurge of guilt and frustration for the near future. Therapy is often needed to provide a safe environmental venue to discuss and address the child’s process and other surrounding issues, reaching compromises and seeking new alternatives in the individual parenting style. Yet another issue is the case of there being too much pressure put on one parent to deal with this particular area in the family life.

Twin studies made on ADHD individuals have proven the same facts. Dr. Florence Levy et al. studied 1938 families with twins and siblings in Australia and found that ADHD has exceptionally high heritability that any other behavioral disorder. The results showed a striking 82% concordance rate for ADHD in identical twins. The concordance rate was only 38% for ADHD in non-identical twins. No support in research has been found on that ADHD is the result of poor parenting or other family environment variables. However, findings do support a worsening of the condition with the use of an unsuitable parenting style. Some external factors such as overly amounts of pre-natal exposure to toxins such as tobacco and alcohol have also found to affect the hyperactivity factor, as well as brain injury or other trauma or disease. However, such cases seem to be atypical and also not yet researched enough to be further explored upon.

The impairments in individuals with dysfunction in EF are as varied as the IQ scores differing from individual to individual. Yet however different these effects are they manifest in such forms, amongst many as the re-reading of text, regulating appropriate processing speed for various tasks, becoming drowsy when performing uninteresting tasks, a low threshold for frustration and difficulty in looking pass irrelevant environmental conditions. ADHD individuals often times find themselves to be very easily distracted and unable to shut out irrelevant stimuli from the surroundings. Do high IQ individuals with ADHD also run into these types of problems? And just how varied can the impairment in EF be? Biederman et al. (2006) completed a study made on a group of 200 ADHD individuals, where he compared the amount of EF impairment. Beiderman was able to identify a subgroup who were particularly impaired in EF (36%) comparing to 16% for the remaining participants. Yet even though the neurological basis found out by Neuropsychology have been found to be helpful, significant controversy still exists to whether these findings readily asses the impairments connected with EF manifested in the daily routine of ADHD individuals. This is because of previous research studying EF impairment on a much more varied range of subjects which did not properly address the problem to whether high IQ adults also ran into the same problems. Although there has been some research done on ADHD patients with particularly high IQ (≥ 120). This type of research is relatively new and uncommon, even more so the research on ADHD females. Returning to the individuals with high IQ and ADHD, they are certainly a minority amongst the ADHD population, but they are special. There is an estimation that these individuals are about 9% of that of the general ADHD population. Individual reports have shown that in many cases individuals have sought treatment and evaluation for many of the chronic difficulties related to ADHD such as excessive forgetfulness, organizing difficulties, chronic lateness, and procrastination upon finally receiving a diagnosis for the condition. Reports also show that these individuals have no problem in working effectively on tasks were there is a strong personal interest, but have much difficulty completing daily life tasks because of the perceived mundane or uninteresting quality of the task at the moment. These high IQ individuals certainly run into constant problems in life, yet most of them understand that some task really are vital to complete if they want to avoid the negative consequences of procrastination.

A recent study made by E. Brown et al. (2009) have tried to explore upon the fact of IQ and ADHD, as well as looking into the different levels of EF impairment. The research team took a group of 157 ADHD adults with IQ ≥ 120 and assessed their EF with 8 measures (deemed reliable) of EF including 5 subscales of normative self-markers. On all the trials of measurement, EF impairment was found to be significantly greater than that of the general population. The cognitive strengths of these individuals were high in some areas such as verbal and perceptual intelligence which was measured by the WAIS-III IQ test. However, significant impairment was also found on doing the WMS-II IQ test which measures memory. Memory impairment was found in as much as 74% of the individuals on tasks strictly involving short term memory where patients had to recall a story they had read. Perhaps this finding is one of the reason why many individuals with ADHD tend to be creatively inclined to fill in the gaps of a rather malfunctioning short term memory. Either way, it is important to note that no studies have shown impairment in long term memory whatsoever.

As regards to EF, 73% of the ADHD individuals showed significant impairment in at least five of the eight markers of EF impairment. This clearly illustrates that individuals with ADHD and high IQ show multiple impairments in EF, regardless of having a high IQ. A factor that could be questionable is that such EF impairments could also be caused by substance abuse as well as anxiety and mood disorders. However, in the method of the study itself, adequate interviews combined with clinical data, with readily available self-reports help to clarify the levels of co-morbid factors such as just mentioned. The study also showed that many of the individuals were not evaluated until high school or even years beyond and that most of the subject reported to have experienced noteworthy pressure from teachers and parents whilst growing up.

As far as IQ tests go in general in measuring mental ability it could be easily inferred that ADHD individuals would score lower on IQ tests due to inattention as the condition is likely to interfere with efficient test taking strategies. Results by administering the Wechsler intelligence scale as mentioned previously have showed that ADHD individuals show significantly lower scores on memory. This might also be linked to the requirement of sustaining mental effort, which might turn out to become very tedious for the individual after a while, especially if the test is deemed to be uninteresting. Instructions may also be disregarded or not properly understood from administrator to administrator. Instructions might also not be spoken clear enough as regards to the use of language or might not be repeated a second time.

The main test to screen the impulsivity factor of ADHD as well as deterioration of attention (more applicable to ADD) over time is the Tests of Variable Attention (TOVA). This test takes about 22 minutes to complete and has also been used to predict and monitor medication effects. It is often used together with a set of other IQ tests to detect ADHD in a test-taking-situation.

Another aspect particularly active in test-taking situations such as an IQ test is the common complaint and inability of ADHD individuals to turn of irrelevant stimuli mentioned previously. The inability to properly regulate one’s emotions might also interfere with the results of the test.[9]

More positive results suggested that ADHD individuals are more likely to show strengths on tasks assessing perceptual organization. ADHD children also performed better in activities where there seemed to be more interest and involvement.

In terms of social and emotion intelligence children with ADHD are often aware of how their being perceived by their surroundings. Aggressive, hyperactive and impulsive behavior amongst peers and adult may cause problems. Social skill training can help improve these symptoms, facilitating success in the classroom and at home. Cognitive Behavior Therapy (CBT) as well as Psychotherapy have been found to be especially beneficial to children with ADHD in developing a more vast understanding of their own and others feelings in a given situation.[10]

 

Discussion

ADHD/ADD seems to be a complex disorder were individuals can have various amounts of EF deficits and various coping strategies for dealing with the condition. Individuals also seem to be able to have different levels of intelligence. Having ADHD does not infer being intellectually disabled. Low, average and high IQ individuals with the condition have been found to have the same difficulties with their management of ADHD. Perhaps a positive social environment help provide the needed strategies for both scholar success as well as emotional stability.

A large amount of ADHD individuals seem to live in unawareness of their condition which would seem to lead to negative effects in these individuals lives. Another thing that seems to be important is for ADHD individuals to focus on their strengths and not their weaknesses in order to feel good about themselves, because the disorder is clearly not a matter of willpower.

Medication and therapy would certainly also help solve many of the issues following the disorder. Public awareness needs also to be raised removing the stigma and misconceptions of ADHD.

More studies on individuals with high and ADHD would be another way of raising awareness of the condition, as well as communicating these findings to the media.

I think it is important to be aware of that a diagnosis of ADHD is also not the finish line. It would certainly help to raise individual awareness, consequently reducing shame and guilt over past behavior and the following of events. There is also a tendency for ADHD children to be treated with more negative attention due to their tendency to be less compliant in general. These symptoms have been found to be reduced by parents who provide appropriate accommodation and interventions.

For parents in need of assistance there are numerous techniques available for the types of intervention, particularly regarding school. These include focusing on the child’s unique interest and strengths as well as implementing regular routines for school work with suiting positive appraisal for the successful organization of one’s time. As motivation difficulties stem mainly from the environment were tasks found tedious for ADHD individuals can often be completed with proper environmental support.

The whole idea with this research synthesis was to find out more about current research on ADHD/ADD and to generate a clear and wide picture of the condition intertwined with intelligence, as well as other related aspects.  I also wanted to clear out some misconceptions and get all the different views from both social, clinical and neuropsychology in order to form a cohesive whole.

 


References

Austin, M. Burgdorf, L. Reiss, N, S. (2007). Other ADHD Treatment Options – Environmental Approaches. MentalHelp.net. p.22. Retrieved from http://www.mentalhelp.net/poc/viewdoc.php?type=doc&id=13866&cn=3

Donald, M, Q. Thomas E, B. Philipp C, R. (2009). Executive Function Impairments in High IQ Adults With ADHD. Jounral of Attention Disorders OnlineFirstXX(X), 1-7. doi: 10.1177/1087054708326113. Retrieved from http://www.drthomasebrown.com/pdfs/HighIQAdults.JADonlineversion.pdf

Barkley, R. Rodgers J. (2009). Attention Deficit Disorder. Knol – a unit of knowledge. Retrieved from http://knol.google.com/k/russell-a-barkley-ph-d/attention-deficit-hyperactivity/l2SXavv/ZKHmPA#

Brown, T, E. (2008). Executive: Describing Six Aspects of a Complex Syndrome. Executive Functions Magazine. 1-17. Retrieved from http://www.drthomasebrown.com/pdfs/ExecutiveFunctionsbyThomasBrown.pdf

Brown, T, E. Reichel, P, C. Quinlan, D, M. (2011). Executive function impairments in   high IQ children and  adolescents with ADHD. Open Journal of Psychiatry, X(1), 56-65. Retrieved from  http://www.drthomasebrown.com/pdfs/OJPsych.HighIQKidswithADHD.pdf

Calvetti, D. Occhipinti, R. Somersalo, E. (2010). Energetics of inhibition: insights with a             computational model of the human GABAergic neuron–astrocyte cellular complex. Journal of Cerebral Blood Flow & Metabolism. 30, 1834–1846. Retrieved from http://www.nature.com/jcbfm/journal/v30/n11/full/jcbfm2010107a.html

Camille, F. Castillo, M. Helen, C. Stephen, H. R. Lester, K. (2004). Neurometabolic    Functioning and Neuropsychological Correlates in Children With ADHD-H: Preliminary Findings. The Journal of Neuropsychiatry and Clinical Neurosciences, 66(1), 63-69. doi: 10.1176/appi.neuropsych.16.1.63. Retrieved from http://neuro.psychiatryonline.org/article.aspx?articleID=101853

Hayden, E. (2010). Why Thinking About Nothing Is So Hard. The Atlantic Wire. Retrieved     from http://www.theatlanticwire.com/technology/2010/09/why-thinking-about-nothing-is-so-hard/18855/

 

[1] Donald, M, Q. Thomas E, B. Philipp C, R. (2009). Executive Function Impairments in High IQ Adults With ADHD. Jounral of Attention Disorders OnlineFirst, 1-7.

[2] Barkley, R. Rodgers J. (2009). Attention Deficit Disorder. Knol – a unit of knowledge.

[3] Camille, F. Castillo, M. Helen, C. Stephen, H. R. Lester, K. (2004). Neurometabolic Functioning and Neuropsychological Correlates in Children With ADHD-H: Preliminary Findings. The Journal of Neuropsychiatry and Clinical Neurosciences, 66(1), 63-69.

[4] Calvetti, D. Occhipinti, R. Somersalo, E. (2010). Energetics of inhibition: insights with a computational model of the human GABAergic neuron–astrocyte cellular complex. Journal of Cerebral Blood Flow & Metabolism. 30, 1834–1846.

[5] Hayden, E. (2010). Why Thinking About Nothing Is So Hard. The Atlantic Wire.

[6] Brown, T, E. (2008). Executive: Describing Six Aspects of a Complex Syndrome. Executive Functions Magazine. 1-17.

[7] Brown, T, E. Reichel, P, C. Quinlan, D, M. (2009). Executive Function. Impairments in High IQ Adults With ADHD. Journal of Attention Disorders.

[8] Austin, M. Burgdorf, L. Reiss, N, S. (2007). Other ADHD Treatment Options – Environmental Approaches. MentalHelp.net. p.22.

[9] Brown, T, E. Reichel, P, C. Quinlan, D, M. (2011). Executive function impairments in high IQ children and adolescents with ADHD. Open Journal of Psychiatry, X(1), 56-65.

[10] M. Austin., N. S. Reiss., L. Burgdorf. (2007). Other ADHD Treatment Options. Environmental Approaches. MentalHelp.net. p.4 – 30.

 

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