Gifted people have been misdiagnosed with ADHD to such a degree that the American Psychiatric Association (APA, publisher of the DSM manual, currently valid in the USA and binding for psychiatric diagnostics) issued a warning against premature diagnoses.

A differential diagnosis is not quite so simple.

On the one hand, gifted people show neurophysiological similarities to ADHS patients: The right frontal lobe, located in the cortex, densifies in normally gifted people before the age of 7, in ADHD patients at about 9 years of age, and in gifted people at about 11 years of age (Shaw, Greenstein and others, 2006). In the process of densification, structuring takes place in the brain. Therefore, late densification is likely to be partly responsible for the high level of associations and interconnectedness of the brain. Apart from these positive aspects, this also involves the danger of lacking structure and ADHD symptoms.

At the same time, underexertion leads to deficits regarding:

  • Learning strategies
  • Structuring and organization
  • Frustration tolerance
  • Creating persistence
  • Success and learning motivation

These deficits can lead to symptoms that are easily confused with real ADHD. Yet, there must be a completely different approach to finding a solution to these symptoms.

Thomas Eckerle provides an interesting explanation regarding the development of ADHD and underachievement in gifted people.

  • With any given task, dopamine is released in the brain. This triggers learning processes and thus creates the expectation of a reward.
  • However, this expectation remains unfulfilled, because the gifted person does not experience success with tasks that are too easy.
  • Hence, there is an imbalance of neurotransmitters that are responsible for concentration and focus (e.g. dopamine, noradrenaline and adrenaline). Because of the already released amount of dopamine, failure is learned particularly well, which causes ADHD symptoms and demotivation.

You can find the complete article, as well as several other, highly recommendable articles on the topic of giftedness by Thomas and Anna Eckerle under this link:

It must also be considered that you can have “lice and fleas” at the same time, i.e. one part of the symptoms might actually be due to ADHD, while others could come from underexertion. 

Following James T. Webb, here you find the similarities between ADHD symptoms in comparison to the differences and causes of the symptoms in giftedness.

Congruence Differences/ causes in giftedness
doesn’t keep focus only if underexerted
easily bored/ daydreaming intense cognitive engagement
low endurance only if the task seems irrelevant
impulsiveness Discrepancy between emotional and intellectual development
doesn’t comply to rules/ orders only if they are illogical/ unjust
active and restless high energy level
lack of structure/ chaos Visual style of perception 

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