u/gicort

Hello everyone,

I recently underwent a full neuropsychological evaluation because my psychiatrist suspected ADHD and possibly twice-exceptionality (2e), so he referred me to a neuropsychologist experienced in adult ADHD assessment.

The evaluation included:

• WAIS-IV
• Rey Complex Figure Test
• Executive functioning and ADHD-related scales/tests

The neuropsychologist diagnosed me with moderate combined ADHD, but stated that I do not meet criteria for giftedness / twice-exceptionality mainly because of a 16-point discrepancy between my VCI and PRI scores on the WAIS-IV.

According to her interpretation, this discrepancy would be inconsistent with a gifted cognitive profile. She used the metaphor of “a Ferrari engine trapped in a golf cart” to describe my functioning.

However, my psychiatrist disagrees with several aspects of the interpretation. He believes the context surrounding the testing was not sufficiently considered, especially:

• untreated ADHD at the time of testing,
• chronic anxiety history,
• and the fact that I have been treated with antidepressants for GAD for over 10 years.

Interestingly, the neuropsychologist concluded that I do not currently meet full criteria for GAD, although the testing still showed moderate anxiety traits. My psychiatrist argued that long-term treatment may have partially reduced the visible anxiety profile during testing.

At the moment, he is considering:

• ADHD,
• ADHD + giftedness / 2e,
• and anxiety as overlapping possibilities.

This divergence between professionals has honestly left me confused.

I’ve been reading extensively about ADHD, but I do not fully relate to many “classic” ADHD presentations.

Some personal traits/history that seem relevant:

• extremely talkative and mentally hyperactive since childhood,
• highly curious and investigative,
• tendency to hyperfocus deeply on topics of interest,
• difficulty letting go of unanswered questions or illogical explanations,
• tendency to overwhelm people unintentionally by going too deep into discussions,
• intense intellectual interests often perceived as “too much” or “weird” by others,
• very strong verbal/auditory memory,
• unusually easy language acquisition,
• adaptation to different cultures/languages,
• chronic feeling of being misunderstood socially,
• excellent academic performance with very little studying during childhood/adolescence,
• increasing executive dysfunction only becoming obvious in adulthood with higher life demands.

WAIS-IV results:

• FSIQ: 131
• VCI: 137
• PRI: 121
• WMI: 133
• PSI: 129

WAIS-IV subtests (raw scores):

• Vocabulary: 62
• Similarities: 38
• Comprehension: 33
• Information: 18
• Block Design: 44
• Matrix Reasoning: 17
• Picture Arrangement: 17
• Picture Completion: 25
• Digit Span: 21
• Letter-Number Sequencing: 21
• Arithmetic: 21
• Coding: 88
• Symbol Search: 46

Executive functioning / ADHD-related tests:

BDEFS (Barkley Deficits in Executive Functioning Scale):

• Total Score: Percentile 90
• Time Management: Percentile 95
• Motivation: Percentile 90
• Organization / Problem Solving: Percentile 80
• Emotional Regulation: Percentile 80
• Self-Control: Percentile 60
• ADHD Symptoms Index: Percentile 95
• Dysexecutive Symptoms Index: Percentile 90

ADT (Time Management Inventory):

• 59 affirmative responses indicating significant executive functioning and time-management difficulties.

FDT (Five Digits Test):

• Reading: Percentile 75
• Counting: Percentile 50–75
• Choice / Inhibitory Control: Percentile 50–75
• Alternation / Cognitive Flexibility: Percentile 75–95
• Inhibition Index: Percentile 50–75
• Flexibility Index: Percentile 75–95

ETDAH-AD: Higher elevations in:

• Inattention
• Emotional aspects
• Self-regulation of attention/motivation/action

Lower elevation in:

• Impulsivity

Rey Complex Figure Test: The report described:

• organizational inefficiency,
• executive inconsistency,
• attentional fluctuation,
• and overload under complex/open-ended tasks.

I’m currently starting ADHD medication treatment and considering whether I should seek a second neuropsychological opinion about my tests' results.

I would genuinely appreciate hearing from people familiar with:

• gifted ADHD / 2e presentations,
• heterogeneous WAIS profiles,
• or adults diagnosed later in life.

Does this profile sound more consistent with:

• ADHD alone with high intelligence,
• or a possible twice-exceptional presentation?

33F — ADHD Combined Type + Possible 2e Profile? Looking for perspectives.

I recently underwent a full neuropsychological assessment at age 33 after finally investigating lifelong executive functioning difficulties. I was diagnosed with moderate ADHD combined type, which had never been treated before. I recently started medication and have also been in psychotherapy for many years.

What left me confused is that my psychiatrist and neuropsychologist disagree somewhat on how to interpret my cognitive profile — especially regarding giftedness/high abilities and the extent to which untreated ADHD may have affected some parts of testing and functioning.

WAIS-IV:
FSIQ: 131

VCI: 137
PRI: 121
WMI: 133
PSI: 129

The neuropsychologist considered the 16-point VCI–PRI discrepancy significant enough that she would not formally classify the profile as giftedness in her interpretation. My psychiatrist disagrees and believes untreated ADHD, executive dysregulation and attentional inconsistency may have partially masked some abilities during testing.

One thing that stood out in my assessment was the Rey Complex Figure Test. My report suggested executive dysfunction patterns such as disorganized planning, inefficient visual-spatial organization, attentional inconsistency and cognitive overload during complex tasks. However, the evaluator also noted that my overall reasoning abilities still appeared globally high.

Functionally, I’ve always had a somewhat contradictory profile:

• very strong verbal abilities and conceptual thinking
• intense intellectual curiosity and hyperfocus
• executive dysfunction and attentional inconsistency
• difficulty regulating depth/intensity of attention

When I become interested in a topic, I can spend hours researching and building conceptual connections without noticing time passing. At the same time, I struggle with organization, mental overload, shifting priorities and sustaining attention in less stimulating contexts.

Socially, I’m actually very communicative and extroverted, but I often interpret language literally and can miss subtle social cues such as irony, jokes, or signs that people are becoming mentally saturated during conversations. I tend to ask a lot of questions and go very deep into topics because my curiosity is extremely intense.

Academically, I generally performed very well with relatively little studying, especially in verbal/humanities-based areas, although I struggled more with heavily calculation-based subjects.

I’m mainly trying to understand whether this kind of profile sounds more compatible with:

• ADHD only
• high intelligence + ADHD
• or a genuinely twice-exceptional (2e) presentation.

I’d also be very interested in hearing whether anyone here has seen untreated ADHD significantly affect perceptual reasoning, Rey Complex Figure performance, executive functioning or overall cognitive presentation during assessment.

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EDIT / Additional clarification regarding ADHD-related testing:

I reviewed the report again and these were the main ADHD/executive functioning-related instruments used during assessment:

WAIS-IV

Five Digits Test (FDT)

BDEFS (Barkley Deficits in Executive Functioning Scale)

ETDAH-AD (Adult ADHD Self-Report Scale)

ADT (Time Management Inventory)

Rey Complex Figure Test

WAIS-IV RESULTS

FSIQ: 131

Indexes:

Verbal Comprehension Index (VCI): 137

Perceptual Reasoning Index (PRI): 121

Working Memory Index (WMI): 133

Processing Speed Index (PSI): 129

FDT (Five Digits Test)

Reading: percentile 75

Counting: percentile 50–75

Choice/Inhibitory Control: percentile 50–75

Alternation/Cognitive Flexibility: percentile 75–95

Inhibition Index: percentile 50–75

Flexibility Index: percentile 75–95

Interpretation: preserved to superior performance in structured tasks involving:

inhibitory control,

cognitive flexibility,

processing speed,

and attention.

BDEFS (Barkley Deficits in Executive Functioning Scale)

Total Score: percentile 90

Time Management: percentile 95

Motivation: percentile 90

Organization / Problem Solving: percentile 80

Emotional Regulation: percentile 80

Self-Control: percentile 60

ADHD Symptoms Index: percentile 95

Dysexecutive Symptoms Index: percentile 90

Interpretation: significant executive dysfunction in daily life, especially involving:

time management,

procrastination,

task initiation/completion,

organization,

motivation,

and autonomous self-regulation over time.

ADT (Time Management Inventory)

Total score: 59 affirmative responses

Interpretation: significant difficulties involving:

planning,

prioritization,

sequencing,

maintaining routines,

handling multiple simultaneous demands,

and managing time without external structure.

ETDAH-AD

The report describes greater elevations in:

inattention, emotional aspects, self-regulation of attention/motivation/action.

Lower elevations in: impulsivity.

The qualitative profile includes: attentional inconsistency, executive overload, procrastination, organizational difficulties, difficulty managing multiple demands, emotional interference in executive functioning and worsening performance under stress/overload.

Rey Complex Figure Test

The report described:

• organizational inefficiency,

• executive inconsistency,

• planning difficulties,

• attentional fluctuation,

• and overload under complex/open-ended demands.

One important point repeatedly emphasized throughout the report: there is a strong discrepancy between my performance in highly structured cognitive testing environments vs my functioning in real-life open-ended situations requiring autonomous self-management.

This discrepancy is one of the reasons my psychiatrist believes untreated ADHD may have partially masked aspects of my cognitive profile during testing.