In our clinical practice, adults with IQ scores in and above the superior range have sought evaluation and treatment for chronic difficulties with organizing their work, excessive procrastination, inconsistent effort, excessive forgetfulness, and lack of adequate focus for school and/or employment. They question whether they might have an attention deficit disorder, but often they have been told by educators and clinicians that their superior intelligence precludes their having ADHD.

Typically, these very bright individuals report that they are able to work very effectively on certain tasks in which they have strong personal interest or intense fear of immediate negative consequences if they do not complete the task at once. Yet they are chronically unable to make themselves do many tasks of daily life they recognize as important but do not see as personally interesting at that moment. When provided treatment appropriate for ADHD, these very bright individuals often report significant improvement in their ability to work effectively while their medication is active.

Clinical interviews with patients in this study indicated that individuals with high IQ who have ADHD may be at increased risk of having recognition and treatment of their ADHD symptoms delayed until relatively late in their educational careers because teachers and parents tend to blame the student’s disappointing academic performance on boredom or laziness, especially as they notice the situational variability of their ADHD symptoms.

Like most others with ADHD, these individuals have a few specific domains in which they have always been able to focus very well, for example, sports, computer games, artistic or musical pursuits, reading self-elected materials. Parents and teachers tend to assume that these very bright persons could focus on any other tasks equally well, if only they chose to do so. These observers do not understand that although ADHD appears to be a problem of insufficient willpower, it is not (Brown, 2005).

Many also reported that they often demonstrated considerable prowess in performing specific tasks in which they had little positive personal interest but did experience considerable fear of immediate negative consequences if they did not complete that particular task by some external deadline. Often subjects described this as a character trait, “I’m just a severe procrastinator” or “I always work best under pressure.”

In an unpublished study of 103 treatment-seeking adults with IQ 120 or more diagnosed with ADHD, Brown and Quinlan (1999) found that 42% had dropped out of postsecondary schooling at least once, although some did eventually return to complete a degree. Those data together with this present study suggest that individuals with high IQ and ADHD, despite their strong cognitive abilities, may be at significant risk of educational disruption or failure due to ADHD-related impairments of EF.

Biederman et al. (2006) […] found that adults with ADHD who self-reported elevated levels of EF impairments on the CBS tended to be significantly more impaired on measures of global functioning, had more comorbidities, and held lower current socioeconomic status than did those with or without ADHD who scored below the median on that scale. […]