ArticleTranslational psychiatry2026
The paradox of high IQ in ADHD: dissociable effects on inattention and impulsivity - insights from behavior, cognition & brain in 5138 children.
Article in Translational psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
While Intelligence Quotient (IQ) is widely considered a linear protective factor against attention-deficit/hyperactivity disorder (ADHD), this paradigm fails to capture domain-specific nuances. We investigated whether non-linear relationships between IQ profiles and ADHD symptoms exist in a large cohort of children diagnosed with ADHD using a multidimensional dataset that integrates behavioral assessments, cognitive testing, and neuroimaging data. We examined a cohort of 5138 children aged 6-16 years diagnosed with ADHD, spanning a broad IQ range, and employed Restricted Cubic Spline (RCS) models to characterize the relationships between IQ measures [Full-Scale IQ (FIQ), Verbal IQ (VIQ), and Performance IQ (PIQ)] and core ADHD symptoms [Total scores, Inattention (IA), and hyperactivity/impulsivity subscales (H/IMP)]. This analytical framework was subsequently extended to executive function performance and brain surface area measurements to provide convergent mechanistic evidence. Latent Profile Analysis (LPA) was utilized to validate the non-linear relationship between functional impairments and IQ levels. FIQ demonstrated a linear negative association with total ADHD symptoms (β = -0.026, t = -3.27, p = 0.001). We identified a "double-edged sword" effect for IQ: while VIQ was linearly associated with lower IA scores (β = -0.015, t = -4.10, p < 0.001), it was associated with higher IMP scores (β = 0.007, t = 2.66, p = 0.008). Conversely, PIQ exhibited a dynamic developmental trajectory; the negative correlation between PIQ and IMP observed in childhood inverted into a significant U-shaped relationship in adolescence (p = 0.008). These behavioral findings were substantiated by convergent neuropsychological and neuroanatomical evidence. Finally, LPA validated a distinct "High IQ/High Impulsivity" subtype characterized by unique cognitive profiles. In conclusion, higher IQ appears to be associated with lower levels of inattention but greater impulsivity, potentially through distinct neurocognitive mechanisms. This refutes the model of IQ as a uniform protector and highlights the need to target inhibitory deficits, especially in high-IQ populations.
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