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Peer-reviewedCC BY-NC-NDTranslational psychiatry

The paradox of high IQ in ADHD: dissociable effects on inattention and impulsivity - insights from behavior, cognition & brain in 5138 children.

  • Ningning Liu1,2
  • Gaoding Jia3,4
  • Yinshan Wang4
  • Litanshunbuer A1,2,5
  • Zelin Mu1,2
  • Meixue Wang1,2
  • Meirong Pan1,2
  • Haimei Li1,2
  • Yufeng Wang1,2
  • Qiujin Qian6,7
  • Lu Liu8,9
9 affiliations
  1. 1Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China.
  2. 2NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
  3. 3Shijiazhuang University, Teacher Education Research Center, Shijiazhuang, China.
  4. 4Beijing Normal University, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing, China.
  5. 5Peking University International Hospital, Beijing, China.
  6. 6Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China. [email protected].
  7. 7NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China. [email protected].
  8. 8Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China. [email protected].
  9. 9NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China. [email protected].
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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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Cite

BibTeXRIS
BibTeX
@article{liu2026paradox,
  title = {{The paradox of high IQ in ADHD: dissociable effects on inattention and impulsivity - insights from behavior, cognition & brain in 5138 children.}},
  author = {Ningning Liu and Gaoding Jia and Yinshan Wang and Litanshunbuer A and Zelin Mu and Meixue Wang and Meirong Pan and Haimei Li and Yufeng Wang and Qiujin Qian and Lu Liu},
  journal = {Translational psychiatry},
  year = {2026},
  month = jul,
  doi = {10.1038/s41398-026-04270-5},
  url = {https://europepmc.org/article/MED/42893999},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - The paradox of high IQ in ADHD: dissociable effects on inattention and impulsivity - insights from behavior, cognition & brain in 5138 children.
AU  - Ningning Liu
AU  - Gaoding Jia
AU  - Yinshan Wang
AU  - Litanshunbuer A
AU  - Zelin Mu
AU  - Meixue Wang
AU  - Meirong Pan
AU  - Haimei Li
AU  - Yufeng Wang
AU  - Qiujin Qian
AU  - Lu Liu
PY  - 2026
DA  - 2026/07/01
JO  - Translational psychiatry
DO  - 10.1038/s41398-026-04270-5
UR  - https://europepmc.org/article/MED/42893999
AB  - 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.
SN  - 2158-3188
ER  -