Executive function impairments in high IQ children and adolescents with ADHD

Thomas Edwards Brown, Philipp Christian Reichel, Donald Michael Quinlan

.

DOI: 10.4236/ojpsych.2011.12009                

Abstract

Objective: To demonstrate that high IQ children and adolescents diagnosed with ADHD tend to suffer from executive function (EF) impairments that: a) can be identified with a combination of standardized measures and normed self-report data; and b) occur more frequently in this group than in the general population. Method: From charts of 117 children and adolescents aged 6 to 17 years with high IQ ( ≥ 120) who fully met DSM-IV diagnostic criteria for ADHD, data on 8 normed measures of executive function (EF) were extracted: IQ index scores for working memory and processing speed, a standardized measure of auditory verbal memory, and 5 clusters of the Brown ADD Scale, a normed, age-graded rating scale for ADHD-related executive function impairments in daily life. Significant impairment was computed for each individual relative to age-appropriate norms for each measure and comparisons were made to base-line rates in the general population. Results: Sixty-two percent of participants were significantly impaired on at least 5 of these 8 markers of EF. Chi-square comparisons of scores from these high IQ participants were significantly different (p < 0.001) from standardization norms for each of the eight EF measures. Conclusions: High IQ children and adolescents with ADHD, despite their cognitive strengths, tend to suffer from significant impairments of executive functions that can be assessed with these measures; incidence of these impairments is significantly greater than in the general population. These results are fully consistent with data on high IQ adults diagnosed with ADHD.

Keywords

ADHD; Executive Functions; High IQ; Working Memory; Processing Speed

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Frazier, T.W., H.A. Demaree, et al. (2004). Meta-analysis of intellectual and neuropsychological test performance in attention-deficit/hyperactivity disorder. Neuropschology, 18, 543-555. doi:10.1037/0894-4105.18.3.543
[2]	Katusic, M.Z., Voight, R.G., Colligan, R.C., Weaver, A.L. and Homan, K.J., et al. (2011) Attention-deficit hyperactivity disorder in children with high intelligence quotient: Results from a population-based study. Journal of Developmental and Behavioral Pediatrics, 32, 103-109. doi:10.1097/DBP.0b013e318206d700
[3]	Antshel, K.M., Faraone, S.V., et al. (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. doi:10.1097/CHI.0b013e318172eecf
[4]	Antshel, K.M., S.V. Faraone, et al. (2008) Temporal Stability of ADHD in the High-IQ Population: Results from the MGH Longitudinal Family Studies of ADHD. Journal of American Academy Child & Adolescent Psychiatry, 47, 817-825. doi:10.1097/CHI.0b013e318172eecf
[5]	Castellanos, F.X. (1999) Psychobiology of ADHD. In: Quay, H.C. and Hogan, A.E. Eds., Handbook of Disruptive Behavior Disorders. Kluwer Academic/Plenum Publishers, New York, 179-198.
[6]	Barkley, R.A. (2006) Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. 3th Edition, Guilford Press, New York.
[7]	Barkley, R.A. (2011) Barkley deficits in executive functioning scale (BDEFS). Guilford Press, New York.
[8]	Brown, T.E. (2005) Attention deficit disorder: The unfocused mind in children and adults. Yale University Press, New Haven.
[9]	Brown, T.E. (2009) Developmental complexities of attentional disorders and comorbidities. In Brown T.E. Ed., ADHD comorbidities: Handbook for ADHD complicatons in children and adults. American Psychiatric Publishing, Inc, Washington, 3-22.
[10]	Brown, T.E. (2006) Executive functions and attention deficit hyperactivity disorder: Implications of two conflicting views. International Journal of Disability, Development and Education, 53, 35-46. doi:10.1080/10349120500510024
[11]	Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., et al. (2000) Unity and diversity of executive functions and their contribution to complex ‘frontal lobe’ tasks: A latent variable analysis. Cognitive Psychology, 41, 49-100. doi:10.1006/cogp.1999.0734
[12]	Eslinger, P.J. (1996) Conceptualizing, Describing, and measuring components of executive function. In G.R. Lyon and N.A. Krasnegor, Eds., Attention, Memory and Executive Function. Paul Brookes Publishing Co., Baltimore, 367-395.
[13]	Baumeister, R.F. and Vohs, K.D. Eds., (2004) Handbook of self-regulation: Research, theory and applications. Guilford Press, New York.
[14]	Delis, D.C., Houston, W.S., Wetter, S. Han, S.D., et al. (2007) Creativity lost: The importance of testing executive function in school-age children and adolescents. Journal of Psychoeducational Assessment, 25, 291-240. doi:10.1177/0734282906292403
[15]	Ardila, A., Pineda, D. and Rosselli, M. (2000) Correlation between intelligence test scores and executive function measures. Archives of Clinical Neuropsychology, 15, 31-36.
[16]	Rommelse, N.N.J., Altink, M.E., Oosterlaan, J., Buschgens, C.J.M., Buitelaar, J.K. and Sergeant, J. (2008) Support for an independent familial segregation of executive and intelligence endophenotypes in ADHD families. Psychological Medicine, 38, 1595-1606. doi:10.1017/S0033291708002869
[17]	Schuck, S.E.B. and Crinella F.M. (2005) Why children with ADHD do not have low IQs. Journal of Learning Disabilities, 38, 262-280. doi:10.1097/00004583-199703000-00015
[18]	Seidman, L.J., Biederman, J., Faraone, S.V., Weber, W., Mennin, D. and Jones, J. (1997a) A pilot study of neuropsychological function in girls with ADHD. Journal of American Academy of Child and Adolescent Psychiatry, 36, 366-373. doi:10.1037/0022-006X.65.1.150
[19]	Seidman, L.J., Biederman, J., Faraone, S.V., Weber, W., and Ouellette, C. (1997b) Toward defining a neuropsychology of attention deficit-hyperactivity disorder: Performance of children and adolescents from a large clinically referred sample. Journal of Consulting and Clinical Psychology, 65, 150-160. doi:10.1037/0894-4105.15.4.544
[20]	Seidman, L.J. (2001) Learning disabilities and executive dysfunction in boys with attention-deficit/hyper-activity disorder. Neuropsychology, 15, 544-556. doi:10.1037/0022-006X.68.3.477
[21]	Doyle, A.E., Biederman, J., Seidman, L.J., Weber, W. and Faraone, S.V. (2000) Diagnostic efficiency of neuropsychological test scores for discriminating boys with and without attention-deficit/hyperactivity disorder. Journal of Consulting and Clinical Psychology, 68, 477-488. doi:10.1037/0022-006X.68.3.477
[22]	Doyle, A.E., Faraone, S.V., Dupre, E.P., and Biederman, J. (2001) Separating attention deficit hyperactivity disorder and learning disabilities in girls: A familial risk analysis. American Journal of Psychiatry, 158, 1666-1672. doi:10.1176/appi.ajp.158.10.1666
[23]	Martinussen, R., Hayden, J., et al. (2005) A meta-analysis of working memory impairments in children with attention-deficit hyperactivity disorder. Journal American Academy of Child Adolescent Psychiatry, 44, 377-384. doi:10.1080/13803390500205700
[24]	Martinussen, R. and Tannock, R. (2006) Working memory impairments in children with attention-deficit hyperactivity disorder with and without comorbid language learning disorders. Journal Clinical and Experimental Neuropsychology, 28, 1073-1094. doi:10.1080/13803390500205700
[25]	McInnes, A., T. Humphries, et al. (2003) Listening comprehension and working memory are impaired in attention-deficit hyperactivity disorder irrespective of language impairment. Journal Abnormal Child Psychology, 31, 427-443. doi:10.1177/108705470300600401
[26]	Quinlan, D. M. and Brown, T.E. (2003) Assessment of short-term verbal memory impairments in adolescents and adults with ADHD. Journal of Attention Disorders, 6, 143-152. doi:10.1177/108705470300600401
[27]	Shanahan, M.A., Pennington, B.F., et al. (2006) Processing speed deficits in attention deficit/hyperactivity disorder and reading disability. Journal of Abnormal Child Psychology, 34, 585-602. doi:10.1007/s10802-006-9037-8
[28]	Bedard, A.C., Jain, U., Hogg-Johnson, S. and Tannock, R. (2007) Effects of methylphenidate on working memory components: Influence of measurement. Journal of Child Psychology and Psychiatry, 48, 872-880. doi:10.1111/j.1469-7610.2007.01760.x
[29]	Rapport, M., Alderson, R., Kofler, M., Sarver, D., Bolden, J. and Sims, V. (2008) Working memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): The contribution of executive and subsystem processes. Journal Abnormal Child Psychology, 36, 825-839. doi:10.1007/s10802-008-9215-y
[30]	Rabbitt, P. (1997) Methodologies and models in the study of executive function. In: Rabbitt P. Ed., Methodology of Frontal and Executive Function, Psychology Press Publishers, East Sussex, 1-38.
[31]	Burgess, P.W. (1997) Theory and methodology in executive function research. In: P. Rabbit Ed., Methodology of Frontal and Executive Function, Psychology Press Publishers, East Sussex, 81-116.
[32]	Biederman, J., Petty C., et al. (2008) Discordance between psychometric testing and questionnaire-based definitions of executive functions in individuals with ADHD. Journal of Attention Disorders, 12, 92-102. doi:10.1177/1087054707305111
[33]	Shallice, T. and Burgess, P.W. (1991) Deficits in strategy application following frontal lobe damage in man. Brain, 114, 727-741. doi:10.1093/brain/114.2.727
[34]	Alderman, N., Burgess, P.W., et al. (2003) Ecological validity of a simplified version of the multiple errands shopping test. Journal of the International Neuropsychological Society, 9, 31-44. doi:10.1017/S1355617703910046
[35]	Willcutt, E.G., Doyle, A.E. et al. (2005) Validity of the executive function theory of attention deficit hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57, 1336-1346. doi:10.1016/j.biopsych.2005.02.006
[36]	Wechsler, D. (1991) Wechsler intelligence scale for children. 3rd Edition, The Psychological Corporation, San Antonio.
[37]	Wechsler, D. (2003) Wechsler intelligence scale for children. 4th Edition, The Psychological Corporation, San Antonio.
[38]	Wechsler, D. (1997) Wechsler adult intelligence scale. Third Edition, The Psychological Corporation, San Antonio.
[39]	Brown, T.E. (1996) Brown attention deficit disorder scales for adolescents and adults. The Psychological Corporation, San Antonio.
[40]	Brown, T.E. (2001) Brown attention deficit disorder scales for children and adolescents. The Psychological Corporation, San Antonio.
[41]	Cohen, M.J. (1997) Children’s memory scale manual. The Psychological Corporation, San Antonio.
[42]	Wechsler, D. (1997) Wechsler memory scale. 3rd Edition, The Psychological Corporation, San Antonio.
[43]	Mayes, S.D. and Calhoun, S.L. (2007) Wechsler intelligence scale for children. 3rd-4th edition, predictors of academic achievement in children with attention deficit/hyperactivity disorder. School Psychology Quarterly, 22, 234-249. doi:10.1037/1045-3830.22.2.234
[44]	Seidman, L.J., Doyle A., et al. (2004) Neuropsychological function in adults with attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America, 27, 261-282. doi:10.1016/j.psc.2003.12.005
[45]	Kaufman, A.S. and Lichtenberger, E.O. (2006) Assessing adolescent and adult intelligence. 3rd Edition, John Wiley & Sons, Hoboken.
[46]	Baddeley, A. (2007) Working memory, thought and action. Oxford University Press, New York.
[47]	Brown, T.E., Reichel, P.C. and Quinlan, D.M. (2009) Executive function impairments in high IQ adults with ADHD. Journal of Attention Disorders, 13, 161-171. doi:10.1177/1087054708326113
[48]	Phelps, E. (2005) The interaction of emotion and cognition: The relationship between the human amygdala and cognitive awareness. In: Hassin, R. Uleman J. and Bargh J. A. Eds., The New Unconscious, Oxford University Press, New York, 61-76.
[49]	Glaser, J. and Kihlstrom, J.F. (2005) Compensatory automaticity: Unconscious volition is not an oxymoron. In: Hassin R., Uleman J. and Bargh J. A. Eds., The New Unconscious, New York, Oxford University Press, 171-195.
[50]	Hassin, R.R. (2005) Nonconscious control and implicit working memory. In: Hassin R., Uleman J. and J.A. Bargh Eds., The New Unconscious, Oxford University Press, New York, 196-222.
[51]	Langberg, J., Epstein, J. N., et al. (2008) The transition to middle school is associated with changes in the developmental trajectory of ADHD symptomatology in young adolescents with ADHD. Journal of Clinical Child and Adolescent Psychology, 37, 651-663.
[52]	Faraone, S., Biederman, J., Spencer, T., Mick, E., Murray, K. Petty, C., et al. (2006) Diagnosing adult attention deficit hyperactivity disorder: Are late onset and subthreshold diagnoses valid? American Journal of Psychiatry, 163, 1720-1729. doi:10.1176/appi.ajp.163.10.1720