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Journal of Abnormal Child Psychology

, Volume 47, Issue 2, pp 273–286 | Cite as

Executive Functioning Heterogeneity in Pediatric ADHD

  • Michael J. KoflerEmail author
  • Lauren N. Irwin
  • Elia F. Soto
  • Nicole B. Groves
  • Sherelle L. Harmon
  • Dustin E. Sarver
Article

Abstract

Neurocognitive heterogeneity is increasingly recognized as a valid phenomenon in ADHD, with most estimates suggesting that executive dysfunction is present in only about 33%–50% of these children. However, recent critiques question the veracity of these estimates because our understanding of executive functioning in ADHD is based, in large part, on data from single tasks developed to detect gross neurological impairment rather than the specific executive processes hypothesized to underlie the ADHD phenotype. The current study is the first to comprehensively assess heterogeneity in all three primary executive functions in ADHD using a criterion battery that includes multiple tests per construct (working memory, inhibitory control, set shifting). Children ages 8–13 (M = 10.37, SD = 1.39) with and without ADHD (N = 136; 64 girls; 62% Caucasian/Non-Hispanic) completed a counterbalanced series of executive function tests. Accounting for task unreliability, results indicated significantly improved sensitivity and specificity relative to prior estimates, with 89% of children with ADHD demonstrating objectively-defined impairment on at least one executive function (62% impaired working memory, 27% impaired inhibitory control, 38% impaired set shifting; 54% impaired on one executive function, 35% impaired on two or all three executive functions). Children with working memory deficits showed higher parent- and teacher-reported ADHD inattentive and hyperactive/impulsive symptoms (BF10 = 5.23 × 104), and were slightly younger (BF10 = 11.35) than children without working memory deficits. Children with vs. without set shifting or inhibitory control deficits did not differ on ADHD symptoms, age, gender, IQ, SES, or medication status. Taken together, these findings confirm that ADHD is characterized by neurocognitive heterogeneity, while suggesting that contemporary, cognitively-informed criteria may provide improved precision for identifying a smaller number of neuropsychologically-impaired subtypes than previously described.

Keywords

ADHD Executive function Working memory Inhibition Shifting Heterogeneity 

Notes

Acknowledgements

This work was supported in part by an NIH grant (R34 MH102499-01, PI: Kofler). The sponsor had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors have no conflicts of interest to report.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10802_2018_438_MOESM1_ESM.docx (560 kb)
ESM 1 (DOCX 560 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018
corrected publication May/2018

Authors and Affiliations

  • Michael J. Kofler
    • 1
    Email author
  • Lauren N. Irwin
    • 1
  • Elia F. Soto
    • 1
  • Nicole B. Groves
    • 1
  • Sherelle L. Harmon
    • 1
  • Dustin E. Sarver
    • 2
  1. 1.Department of PsychologyFlorida State UniversityTallahasseeUSA
  2. 2.Departments of Pediatrics and Psychiatry, Center for Advancement of YouthUniversity of Mississippi Medical CenterJacksonUSA

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