Children with ADHD exhibit clinically impairing inattentive behavior during classroom instruction and in other cognitively demanding contexts. However, there have been surprisingly few attempts to validate anecdotal parent/teacher reports of intact sustained attention during ‘preferred’ activities such as watching movies. The current investigation addresses this omission, and provides an initial test of how ADHD-related working memory deficits contribute to inattentive behavior during classroom instruction. Boys ages 8–12 (M = 9.62, SD = 1.22) with ADHD (n = 32) and typically developing boys (TD; n = 30) completed a counterbalanced series of working memory tests and watched two videos on separate assessment days: an analogue math instructional video, and a non-instructional video selected to match the content and cognitive demands of parent/teacher-described ‘preferred’ activities. Objective, reliable observations of attentive behavior revealed no between-group differences during the non-instructional video (d = −0.02), and attentive behavior during the non-instructional video was unrelated to all working memory variables (r = −0.11 to 0.19, ns). In contrast, the ADHD group showed disproportionate attentive behavior decrements during analogue classroom instruction (d = −0.71). Bias-corrected, bootstrapped, serial mediation revealed that 59% of this between-group difference was attributable to ADHD-related impairments in central executive working memory, both directly (ER = 41%) and indirectly via its role in coordinating phonological short-term memory (ER = 15%). Between-group attentive behavior differences were no longer detectable after accounting for ADHD-related working memory impairments (d = −0.29, ns). Results confirm anecdotal reports of intact sustained attention during activities that place minimal demands on working memory, and indicate that ADHD children’s inattention during analogue classroom instruction is related, in large part, to their underdeveloped working memory abilities.
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All children meeting DSM-IV criteria for ADHD-Combined Type met criteria using DSM-5 criteria for ADHD Combined Presentation.
WM performance data for a subset of the current sample were used in separate studies to evaluate conceptually unrelated hypotheses (Alderson et al. 2010, 2012; Friedman et al. 2017a-online early release, b; Kofler et al. 2010, 2011, 2014; Raiker et al. 2012; Rapport et al. 2008, 2009; Sarver et al. 2012). We have not previously reported the instructional and non-instructional video data or their associations with our WM tasks for any children in the current sample.
Alternative approaches were considered but not adopted because they share substantial variance with WM (e.g., the WISC-IV General Ability Index (GAI) is comprised of the Verbal Comprehension and Perceptual Reasoning Indices, which shares 23% to 40% of variance with the WMI; Wechsler 2007).
Briefly, the narrower 90% confidence interval is less likely to include 0.0, and represents a more conservative approach for estimating the magnitude of the relation between diagnostic status and the dependent variable after accounting for the mediator (i.e., partial mediation). For discussion and specific examples of this phenomenon, see Shrout and Bolger (2002). We acknowledge that 90% CIs are less conservative than 95% CIs for evaluating indirect pathways, despite being more conservative for the critical c’ direct pathway. We emphasized the latter based on the rationale that Type II errors were most detrimental for the c’ pathway (i.e., erroneously concluding that children with ADHD are not more inattentive than TD children after accounting for mediators). Current approaches preclude specifying different criteria for each pathway.
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This study was conducted without external funding.
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The authors declare that they have no conflicts of interest.
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/assent was obtained from all participants included in the study.
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Orban, S.A., Rapport, M.D., Friedman, L.M. et al. Inattentive Behavior in Boys with ADHD during Classroom Instruction: the Mediating Role of Working Memory Processes. J Abnorm Child Psychol 46, 713–727 (2018). https://doi.org/10.1007/s10802-017-0338-x
- Attention-deficit/hyperactivity disorder
- Classroom attention
- Working memory
- Classroom instruction