Skip to main content

Verified by Psychology Today


High-Functioning ADHD Is Often Subtle But Still a ‘Mountain’

ADHD can hide its manifestations in intelligent, highly functioning individuals.

Key points

  • ADHD is among the most common psychiatric disorders.
  • ADHD is associated with inattention, poor concentration, distractedness, memory problems, and more.
  • ADHD can hide its manifestations and present as anything but stereotypical in intelligent and highly functioning individuals.
Photo by Tara Winstead from Pexels
Source: Photo by Tara Winstead from Pexels

ADHD is a syndrome involving dysregulation of certain neurological functions and related behaviors and is among the most common psychiatric problems in the world. It is associated with inattention, poor concentration, distractedness, memory problems, lack of organizational and social skills, impulsive behavior, hyperactivity, and intense emotions.

In the words of life coach and therapist Shannon L. Alder, ADHD patients often, “do not know any other way to live than by extremes because their emotional thermostats are broken.”

Yet, to lump all ADHD patients into a homogeneous category is to ignore the subtleties of this complex disorder. Indeed, ADHD can hide its manifestations and be anything but stereotypical in intelligent and highly functioning individuals.

In their recently published book, ADHD 2.0, psychiatrists Edward M. Hallowell, M.D. and John J. Ratey describe many high-performing ADHD patients as having, “a special feel for life, a way of seeing right into the heart of matters, while [more neurotypical individuals] have to reason their way methodically.” Other seemingly positive attributes of the disorder, experts say, include extensive creativity and imagination, generosity, a strong sense of humor, and complete transparency and honesty.

For instance, one ADHD patient, a restaurateur, writing in a 2013 ADHD Awareness Month online newsletter, says her disorder has proven a boon. “It’s easy to do a million things at once… When I found I had ADHD, I finally understood why I had more energy than everyone else.” She turned that energy into a successful business.

ADHD’s Downside

Of course, ADHD is not all roses, far from it. The disorder has significant downsides, leaving its patients spinning through contradictory behavioral characteristics—a “paradox,” as Drs. Hallowell and Ratey point out. Highly functioning individuals with ADHD can be workaholics, yet, at the same time, procrastinators when it comes to completing projects of little interest to them. They are noted for top-flight performance in complex initiatives but struggle with poor planning or a lack of organizational and time-management skills. There is a tendency to make impulsive, not-well-considered decisions; a temptation to assign blame for failure to others; and directional dyslexia (right-left confusion). The “vivid imaginations” that their affliction affords can have both positive and catastrophic results. And they incessantly feel as if, in the words of one ADHD patient, they are always, “climbing mountains,” “abandoning endeavors,” and wrestling with lack of self-confidence.

A study published in a 2017 edition of Lancet Psychiatry indicated that ADHD may be tied to differences in overall brain volume and delayed development of key regions of the brain, including the hippocampus, the amygdala (which is associated with the regulation of emotions), and the nucleus accumbens (which is involved in the brain’s “reward processing” circuit, including development of addictive behaviors like drug dependency and compulsive gambling).

Of equal concern is ADHD’s association with physical disorders and injury. In a 2017 study by the European College of Neuropsychopharmacology, researchers found three-quarters of children and adults with ADHD experience some form of sleep disorder, such as sleeplessness, sleep apnea, restless-leg syndrome, circadian rhythm disturbances, or delays in the physiological changes such as core body temperature, required for sleep. Other studies link ADHD to a 50 percent higher risk for developing diabetes (Journal of Diabetes, 2020) and a 1.45 times greater likelihood of becoming involved in a car crash (Journal of the American Academy of Child and Adolescent Psychiatry, 2020).

Recent statistics indicate that ADHD affects about 8 percent of all children, ages 3-17, and 5 percent of adults—more men than women—in the United States. Most cases of ADHD are readily manageable through behavior therapy, medication, exercise, and diet, but as many as 75 percent of adults with ADHD are not even aware they have a mental disorder—a fact particularly true among the intelligentsia, who oftentimes consider symptoms to be simply flawed personality traits.

What’s the Fix?

Subtle warning signs of ADHD include a hyper-focus on matters only of specific interest, impatience, frequent interruption of others’ conversations, difficulties finding the right words to say, directional confusion, boredom with relationships, an altered sense of time (usually running late), struggles with sleep problems, general fatigue at work, and addictive behaviors. “None of these symptoms, by itself, implies high-functioning adult ADHD. But, in combination, they may indicate the need to consult a therapist about the possibility,” advises the Edge Foundation, an organization of ADHD professionals.

Indeed, the adage, "better the devil you know than the devil you don’t" is born out in a definitive diagnosis of high-functioning ADHD. That’s because awareness of the mental disturbance allows the coping professional to take positive action to control it. These include:

  • Creating and adhering to an events calendar to keep one on track for scheduled meetings, medical appointments, family gatherings, and other activities.
  • Setting time limits on projects to overcome disinterest and procrastination.
  • Crafting a task list that is manageable and not overwhelming.
  • Developing an external—not just mental—plan for completing specific projects.
  • Reducing one’s own high expectations and avoiding comparisons with others’ success.
  • Prioritizing options before making important decisions.
  • Regularly exercising, getting sufficient amounts of sleep, and following a healthy diet.

The authors of ADHD 2.0 warn that ADHD is a “mountain of a condition,” rather than a “molehill.” Indeed, they say, given our high-tech society with its, “lightning-fast access to information,” and the “rapid-firing nature of incoming stimuli,” it is, “probable that all of us are…’a little ADHD’ nowadays—more scatterbrained, forgetful, and unfocused than ever before.”

More from Alex Dimitriu M.D.
More from Psychology Today