Sometimes persons with a higher overall IQ who suffer from ADHD are at greater risk of having their impairments overlooked. At Yale, Donald Quinlan and I studied adults who sought evaluation for chronic atten-tional problems, all of whom had a tested IQ in the superior range; in terms of intelligence, they were in the top 1 to 9 percent of the general population. Despite their very high IQ scores, 42 percent of these men and women had dropped out of their postsecondary schooling at least once, not because they were not smart enough to understand the work, but because they were not able to organize, focus, and sustain their efforts to deal with academic requirements. Some eventually returned to complete their education and achieved success in business or professions; others experienced continuing frustration and failure.
Virtually all of the very bright adults in this Yale study reported that they had suffered chronic and often severe impairments of ADD syndrome that were essentially ignored or denied by their parents, teachers, and themselves for many years. One thirty-eight-year-old woman described her experiences:
I started reading sentences before I was in kindergarten and everyone in my family kept saying that I was so smart. When I was in elementary schools the teachers told my parents that I was almost a genius because I asked so many good questions and knew so much about so many things. In fifth grade they tested my IQ and put me in a special group for "gifted" students. All that changed in middle school when I wasn't keeping up with my homework. I started high school in honors-level classes, but over a couple of years they dropped me out of all of them because I often wasn't prepared. I didn't read what we were supposed to read at home and I almost never did the papers that were assigned.
All that really interested me were the school plays and athletics. The guidance counselor and teachers kept telling my parents that I could do the work, if only I really wanted to; they thought I was lazy. My parents figured I was just bored. They thought the problem was poor teachers and that it would all get better when I went to college.
I got into a really good university because my SAT scores were really high and I had great references from my art and theater teachers. When I got there, I had a great time. There were so many interesting people to hang out with and learn from. But I couldn't get myself organized to get to classes enough and to get the reading done and to write the papers. Everything was always late or just not done. That got me put on probation and eventually they kicked me out in the middle of my second year because I was failing almost everything. For me it was all really interesting, but I just couldn't get organized and do enough of the work. Only after my daughter got diagnosed with ADD did I realize that there was something wrong with me other than laziness, a problem that could get fixed. Nobody including me thought that such a smart person could have any real problem in school.
Even today many educators and clinicians do not realize that those executive functions crucial to effective performance as a student can be severely impaired even in individuals who are very bright and talented. In many schools and families, bright but disorganized and poorly performing students with ADHD are still seen as stubbornly lazy, unmotivated, or defiant. Well-intentioned but uninformed teachers and parents often pun ish these bright, extremely inconsistent students for what appears to be a lack of motivation or a refusal to do what they need to do.
Perhaps worse than punishments meted out by frustrated teachers and parents is the self-criticism experienced by these extremely bright but floundering students. Often their ambitions and expectations for themselves have been inflated by accomplishments and recognition obtained in earlier years, when less focus and self-management was required. When confronted by the intensified academic challenges of some high school honors classes or university courses, many very bright individuals with ADD syndrome get so frustrated and demoralized that they give up on their education.
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