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Adults with superior I.Q.s and ADD/ADHD face unique risks that can spell failure academically and professionally, according to the results of a study presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry (AACAP) in October.
One hundred and three adults who participated in a study last year had I.Q.’s of at least 120 on the verbal or performance sections or both when tested on the revised Wechsler Adult Intelligence Scale, and all met the diagnostic criteria for ADHD, either the combined type or predominantly the inattentive type.
Their I.Q.’s put them in the top 9 percent of the general population, said Thomas Brown, Ph.D., who conducted the study and presented the results at the Toronto AACAP meeting. Brown is associate director of the Yale Clinic for Attention and Related Disorders in New Haven, Conn.
"Increasingly, we are seeing that ADD is a problem of executive function in which specific areas of the brain are impaired that provide central control, and connect, prioritize, and integrate other functions," Brown said. "A key element of executive function is a working memory, which allows an individual to hold onto information, manipulate it, and retrieve it from long-term memory."
Brown noted that 60 percent of the participants tested at or below the 75th percentile on subsets of the I.Q. test that required short-term concentration and working memory.
"Nonetheless, their overall verbal or performance I.Q. scores were high enough to carry the lower scores," said Brown.
He explained that he was especially interested in this sample "because all the participants had similar intellectual abilities, but some were very successful while others had severe difficulty."
The researchers rated 18 percent of the sample as being very well adjusted, because they achieved educational and employment levels consistent with their intellectual abilities, were financially independent, maintained at least one stable social relationship, and had no drug or alcohol abuse problems at the time of the study.
Most participants were rated well adjusted to adequately adjusted (44 percent and 30 percent, respectively) because they were able to meet at least two or more of the researchers’ criteria.
Not surprisingly, educational achievement was positively correlated with being well adjusted. For example, everyone in the very well-adjusted group had at least a bachelor’s degree; 78 percent also had a master’s degree, and 17 percent a doctoral degree.
Those participants tended to include the highest number of professionals including doctors, lawyers, and business people, noted Brown.
In contrast, a little more than half of the poorly adjusted group (11 percent of the sample) had dropped out of college. Only 9 percent completed a bachelor’s degree, and none had a master’s or doctoral degree. Despite their superior intelligence, those participants tended to be in unskilled jobs or unemployed, noted Brown.
Comorbid psychiatric disorders were nearly entirely correlated with poorer levels of adjustment. Fifty-six percent of the poorly functioning group had major depressive disorder, 82 percent had dysthymia, and 9 percent were diagnosed with bipolar disorder.
In contrast, only 6 percent of the top-functioning group suffered from major depressive disorder, 28 percent had dysthymia, and 6 percent had bipolar disorder.
"Interestingly, 17 percent of the best-adjusted group met the diagnostic criteria for generalized anxiety disorder. Nervousness in an individual with ADD can be helpful in containing some of the impulsive responses and keeping the person moving toward his or her goals," observed Brown.
The poorly adjusted group had the highest levels of panic disorder (9 percent), social phobia (19 percent), and alcohol and drug abuse (10 percent and 20 percent, respectively).
"Substance abuse, depression, social phobia, learning disorders, and panic disorder all contributed to poor adjustment outcomes," said Brown.
Participants in the very well-adjusted group also reported that they had parents or mentors who were very supportive of their strengths and were not locked into battles over control or excessively critical, added Brown. Other factors contributing to their success were proven abilities in sports or the arts, holding jobs while in college, and having "functional" friends.