to the editor: In response to the article "Attention-Deficit/Hyperactivity Disorder: Management,"¹ by Drs. Szymanski and Zolotor, I would recommend that readers consider intelligence in the differential diagnosis. I have started ordering IQ testing on select patients and have found a fair number of geniuses among this population who would otherwise meet the criteria for treatment. These children, some of whom have IQs greater than the average physician’s IQ of 126, are not challenged by repetitive curricula and need additional and more complex assignments to hold their interest. They should also be placed with the best teachers because many can outsmart their adult instructors.

in reply: Dr. Woodhouse's point is well taken. However, I would not advocate routine IQ testing for all patients evaluated with attention-deficit disorder (ADD). I agree that for a select group of patients, IQ testing may reveal the bored, yet unrecognized genius, who would likely be better served by changes in the learning environment. Nevertheless, keep in mind that intelligence and attention deficits are thought to be independent factors that influence ones ability to function academically and interpersonally. A diagnosis of ADD does not indicate a low IQ, and a high IQ does not eliminate the potential existence of attention deficits. The decision to intervene in whatever fashion (e.g., medication, further neuropsychological evaluation, change of academic/work environment, counseling) is complex; this decision should be influenced by the quality and severity of initial dysfunctional behavior and academic difficulty. Further evaluation should definitely be considered before medication is prescribed in patients where there is a significant discrepancy in the observations of different persons or when the patient is in different settings. Similarly, if a medication trial fails to meet treatment goals, further evaluation might turn up a common comorbidity (e.g., depression, sleep disorder, hyperfocused/compulsive, aggressive/oppositional) as well as the learning disabled or the emotionally impaired student.