Executive Dysfunctions in Attention-Deficit Hyperactivity Disorder

  • Shameem FatimaEmail author


The chapter focuses on executive dysfunctions in attention-deficit hyperactivity disorder. Initially, the presenting symptoms, types, and prevalence rate of the disorder are described. Next, executive dysfunctions in relation to symptoms of the disorder have been analyzed. Individuals with attention-deficit hyperactivity disorder show consistent impairment on inhibition, working memory, and sustained attention measures of executive functioning. Also, these individuals show deficits of self- and emotion regulation processes. Further, specific executive dysfunctions have been analyzed in relation to functional consequences. This part discusses that these individuals show poor academic and occupational performance, poor social and family relationships, and emotional regulation problems of aggression, frustration, etc. that are linked with executive dysfunctions. Then, symptoms are briefly discussed in relation to neuro-anatomical and biochemical processes. Finally, treatment strategies to target the symptoms as well as related executive dysfunctions and comorbid disorder are discussed.


ADHD Inhibition Attention Working memory Self-regulation 


  1. Ahmadi, N., Goodarzi, M. A., Hadianfard, H., Mohamadi, N., Farid, D., et al. (2013). Comparing iconic memory in children with and without attention deficit hyperactivity disorder. Iranian Journal of Psychiatry, 8(3), 131–137.PubMedPubMedCentralGoogle Scholar
  2. Alloway, T. P., & Alloway, R. G. (2010). Investigating the predictive roles of working memory and IQ in academic attainment. Journal of Experimental Child Psychology, 106(1), 20–29.PubMedGoogle Scholar
  3. Alloway, T. P., Elliott, J., & Place, M. (2010). Investigating the relationship between attention and working memory in clinical and community samples. Child Neuropsychology, 16(3), 242–254.Google Scholar
  4. Alloway, T. P., Gathercole, S. E., & Elliott, J. (2010). Examining the link between working memory behavior and academic attainment in children with ADHD. Developmental Medicine & Child Neurology, 52(7), 632–636.Google Scholar
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC, USA: American Psychiatric Association.CrossRefGoogle Scholar
  6. Anderson, V. A., Anderson, P., Northam, E., Jacobs, R., & Catroppa, C. (2001). Development of executive functions through late childhood and adolescence in an Australian sample. Developmental Neuropsychology, 20(1), 385–406.PubMedCrossRefGoogle Scholar
  7. Arnett, A. B., MacDonald, B., & Pennington, B. F. (2013). Cognitive and behavioral indicators of ADHD symptoms prior to school age. Journal of Child Psychology and Psychiatry and Allied Disciplines, 54, 1284–1294.CrossRefGoogle Scholar
  8. Arnsten, A. F. (2009). Toward a new understanding of attention-deficit hyperactivity disorder pathophysiology: An important role for prefrontal cortex dysfunction. CNS Drugs, 23, 33–41.PubMedCrossRefGoogle Scholar
  9. Arnsten, A. F., & Li, B. M. (2005). Neurobiology of executive functions: Catecholamine influences on prefrontal cortical functions. Biological Psychiatry, 57(11), 1377–1384.PubMedCrossRefGoogle Scholar
  10. Arnsten, A. F., Steere, J. C., & Hunt, R. D. (1996). The contribution of alpha 2-noradrenergic mechanisms of prefrontal cortical cognitive function. Potential significance for attention deficit hyperactivity disorder. Archives of General Psychiatry, 53, 448–455.PubMedCrossRefGoogle Scholar
  11. Baker, K. (2013). Conduct disorders in children and adolescents. Paediatrics and Child Health, 23, 24–29.CrossRefGoogle Scholar
  12. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65–94.CrossRefGoogle Scholar
  13. Barkley, R. A. (2006). A theory of ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder. A handbook for diagnosis and treatment (pp. 297–334). New York, NY: Guilford Press.Google Scholar
  14. Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2004). Young adult follow-up of hyperactive children: Antisocial activities and drug use. Journal of Child Psychology and Psychiatry, 45, 24–36.CrossRefGoogle Scholar
  15. Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. New York, NY: Guilford Press.Google Scholar
  16. Berger, A., & Posner, M. (2000). Pathologies of brain attentional networks. Neuroscience & Biobehavioral Reviews, 24(1), 3–5.CrossRefGoogle Scholar
  17. Biederman, J., Faraone, S. V., Spencer, T., Wilens, T., Norman, D., Lapey, K. A., et al. (1993). Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry, 150(12), 1792–1798.PubMedCrossRefGoogle Scholar
  18. Boutros, N., Fraenkel, L., & Feingold, A. (2005). A four-step approach for developing diagnostic tests in psychiatry: EEG in ADHD as a test case. Journal of Neuropsychiatry and Clinical Neuroscience, 17, 455–464.CrossRefGoogle Scholar
  19. Breslau, J., Miller, E., Breslau, N., Bohnert, K., Lucia, V., & Schweitzer, J. (2009). The impact of early behavior disturbances on academic achievement in high school. Pediatrics, 123(6), 1472–1476.PubMedPubMedCentralCrossRefGoogle Scholar
  20. Bruckmann, S., Hauk, D., Roessner, V., Resch, F., Freitag, C. M., Kammer, T., et al. (2012). Cortical inhibition in attention deficit hyperactivity disorder: New insights from the electroencephalographic response to transcranial magnetic stimulation. Brain, 135, 2215–2230.PubMedCrossRefGoogle Scholar
  21. Castellanos, F. X. (1997). Toward a pathophysiology of attention-deficit/hyperactivity disorder. Clinical Pediatrics, 36, 381–393.PubMedCrossRefGoogle Scholar
  22. Cherkasova, M., Sulla, E. M., Dalena, K. L., Pondé, M. P., & Hechtman, L. (2013). Developmental course of attention deficit hyperactivity disorder and its predictors. Journal of Canadian Academy of Child and Adolescent Psychiatry, 22(1), 47–54.Google Scholar
  23. Cortese, S., Kelly, C., Chabernaud, C., Proal, E., Di Martino, A., Milham, M. P., et al. (2012). Toward systems neuroscience of ADHD: A meta-analysis of 55 fMRI studies. American Journal of Psychiatry, 169, 1038–1055.PubMedCrossRefGoogle Scholar
  24. Currie, J., & Stabile, M. (2006). Child mental health and human capital accumulation: The case of ADHD. Journal Health Economics, 25(6), 1094–1118.CrossRefGoogle Scholar
  25. Davis, N. O., & Kollins, S. H. (2012). Treatment for co-occurring attention deficit/hyperactivity disorder and autism spectrum disorder. Neurotherapeutics, 9(3), 518–530.PubMedPubMedCentralCrossRefGoogle Scholar
  26. De La Fuente, A., Xia, S., Branch, C., & Li, X. (2013). A review of attention-deficit/hyperactivity disorder from the perspective of brain networks. Frontiers in Human Neuroscience, 7.Google Scholar
  27. Diamond, A., Barnett, W. S., Thomas, J., & Munro, S. (2007). Preschool program improves cognitive control. Science, 318(5855), 1387–1388.PubMedPubMedCentralCrossRefGoogle Scholar
  28. Dickstein, S. G., Bannon, K., Castellanos, F. X., & Milham, M. P. (2006). The neural correlates of attention deficit hyperactivity disorder: An ALE meta-analysis. Journal of Child Psychology and Psychiatry, 47(10), 1051–1062.PubMedCrossRefGoogle Scholar
  29. Doyle, A. E. (2006). Executive functions in attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 67, 21–26.PubMedGoogle Scholar
  30. DuPaul, G. J., Volpe, R. J., Jitendra, A. K., Lutz, J. G., Lorah, K. S., et al. (2004). Elementary school students with AD/HD: Predictors of academic achievement. Journal of School Psychology, 42, 285–301.CrossRefGoogle Scholar
  31. Faraone, S. V., & Biederman, J. (1997). Do attention deficit hyperactivity disorder and major depression share familial risk factors? Journal of Nervous and Mental Disorder, 185(9), 533–541.CrossRefGoogle Scholar
  32. Frazier, T. W., Youngstrom, E. A., Glutting, J. J., & Watkins, M. W. (2007). ADHD and achievement: Meta-analysis of the child, adolescent, and adult literatures and a concomitant study with college students. Journal of Learning Disabilities, 40(1), 49–65.PubMedCrossRefGoogle Scholar
  33. Galera, C., Melchior, M., Chastang, J. F., Bouvard, M. P., & Fombonne, E. (2009). Childhood and adolescent hyperactivity-inattention symptoms and academic achievement 8 years later: The GAZEL Youth study. Psychological Medicine, 39(11), 1895–1906.PubMedPubMedCentralCrossRefGoogle Scholar
  34. Gargaro, B. A., Rinehart, N. J., Bradshaw, J. L., Tonge, B. J., & Sheppard, D. M. (2011). Autism and ADHD: How far have we come in the comorbidity debate? Neuroscience and Biobehavioral Reviews, 35(5), 1081–1088.PubMedCrossRefGoogle Scholar
  35. Giannopulu, I., Escolano, S., Cusin, F., Citeau, H., & Dellatolas, G. (2008). Teachers’ reporting of behavioural problems and cognitive-academic performances in children aged 5–7 years. British Journal of Educational Psychology, 78, 127–147.PubMedCrossRefGoogle Scholar
  36. Hart, H., Radua, J., Nakao, T., Mataix-Cols, D., & Rubia, K. (2013). Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: Exploring task-specific, stimulant medication, and age effects. JAMA Psychiatry, 70, 185–198.PubMedCrossRefGoogle Scholar
  37. Johnson, K. A., Robertson, I. H., Kelly, S. P., et al. (2007). Dissociation in performance of children with ADHD and high-functioning autism on a task of sustained attention. Neuropsychologia, 45(10), 2234–2245.PubMedPubMedCentralCrossRefGoogle Scholar
  38. Johnson, M., Ostlund, S., Fransson, G., Kadesjö, B., & Gillberg, C. (2009). Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder: A randomized placebo-controlled trial in children and adolescents. Journal of Attention Disorders, 12(5), 394–401.PubMedCrossRefGoogle Scholar
  39. Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., et al. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723.PubMedCrossRefGoogle Scholar
  40. Knight, L. A., Rooney, M., & Chronis-Tuscano, A. (2008). Psychosocial treatments for attention deficit/hyperactivity disorder. Current Psychiatry Reports, 10(5), 412–418.PubMedCrossRefGoogle Scholar
  41. Kofler, M. J., Rapport, M. D., Bolden, J., & Altro, T. A. (2008). Working memory as a core deficit in ADHD: Preliminary findings and implications. The ADHD Report, 16, 8–14.CrossRefGoogle Scholar
  42. Konofal, E., Lecendreux, M., Arnulf, I., & Mouren, M. C. (2004). Iron deficiency in children with attention-deficit/hyperactivity disorder. Archives of Pediatrics & Adolescent Medicine, 158(12), 1113–1115.CrossRefGoogle Scholar
  43. Loe, I. M., & Feldman, H. M. (2007). Academic and educational outcomes of children with ADHD. Journal of Pediatric Psychology, 32(6), 643–654.PubMedCrossRefGoogle Scholar
  44. Martel, M. M., & Nigg, J. T. (2006). Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47, 1175–1183.CrossRefGoogle Scholar
  45. Martinussen, R., Hayden, J., Hogg-Johnson, S., & Tannock, R. (2005). A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44(4), 377–384.PubMedCrossRefGoogle Scholar
  46. McLoughlin, G., Palmer, J. A., Rijsdijk, F., & Makeig, S. (2014). Genetic overlap between evoked frontocentral theta-band phase variability, reaction time variability, and attention-deficit/hyperactivity disorder symptoms in a twin study. Biological Psychiatry, 75, 238–247.PubMedCrossRefGoogle Scholar
  47. Menezes, A., Dias, N. M., Trevisan, B. T., Carreiro, L. R., & Seabra, A. G. (2015). Intervention for executive functions in attention deficit and hyperactivity disorder. Arqquivos di Neuro-Psiquiatria, 73(3), 227–236.CrossRefGoogle Scholar
  48. Merrell, C., & Tymms, P. B. (2001). Inattention, hyperactivity and impulsiveness: Their impact on academic achievement and progress. British Journal of Educational Psychology, 71(1), 43–56.PubMedCrossRefGoogle Scholar
  49. Milich, R. B., Balentine, A. C., & Lynam, D. R. (2001). ADHD combined type and ADHD predominantly inattentive type are distinct and unrelated disorders. Clinical Psychology: Science and Practice, 8, 463–488.Google Scholar
  50. Molina, B. S., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., et al. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 484–500.PubMedPubMedCentralCrossRefGoogle Scholar
  51. Moore, T. L., Schettler, S. P., Killiany, R. J., Rosene, D. L., & Moss, M. B. (2012). Impairment in delayed nonmatching to sample following lesions of dorsal prefrontal cortex. Behavioral Neuroscience, 126(6), 772–780.PubMedPubMedCentralCrossRefGoogle Scholar
  52. Nigg, J. T. (2000). On inhibition/disinhibition in developmental psychopathology: Views from cognitive and personality psychology and a working inhibition taxonomy. Psychological Bulletin, 126(2), 220–246.PubMedCrossRefGoogle Scholar
  53. Nigg, J. T. (2001). Is ADHD a disinhibitory disorder? Psychological Bulletin, 127(5), 571–598.PubMedCrossRefGoogle Scholar
  54. Paloscia, C., Baglioni, V., Alessandrelli, R., Rosa, C., Guerini, R., Aceti, F., et al. (2013). Executive function deficits in ADHD and Asperger syndrome. Rivista di Psichiatria, 48(6), 441–447.PubMedGoogle Scholar
  55. Pelham, W. E., Jr., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 37(1), 184–214.PubMedCrossRefGoogle Scholar
  56. Pennington, B. F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, 37(1), 51–87.PubMedCrossRefGoogle Scholar
  57. Petrides, M. (2000). The role of the mid-dorsolateral prefrontal cortex in working memory. Experimental Brain Research, 133(1), 44–54.PubMedCrossRefGoogle Scholar
  58. Pliszka, S. R. (2000). Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child & Adolescent Psychiatric Clinics of North America, 9(3), 525–540.CrossRefGoogle Scholar
  59. Puentes-Rozo, P. J., Barceló-Martínez, E., & Pineda, D. A. (2008). Behavioral and neuropsychological characteristics of children of both sexes, between 6 and 11 years of age, with attention deficit hyperactivity disorder. Revista de Neurologia, 47, 175–184.PubMedCrossRefGoogle Scholar
  60. Ranby, K. W., Boynton, M. H., Kollins, S. H., McClernon, F. J., Yang, C., & Fuemmeler, B. F. (2012). Understanding the phenotypic structure of adult retrospective ADHD symptoms during childhood in the United States. Journal of Clinical Child and Adolescence Psychology, 41, 261–274.CrossRefGoogle Scholar
  61. Rapport, M. D., Chung, K. M., Shore, G., & Isaacs, P. (2001). A conceptual model of child psychopathology: Implications for understanding attention deficit hyperactivity disorder and treatment efficacy. Journal of Clinical Child Psychology, 30(1), 48–58.PubMedCrossRefGoogle Scholar
  62. Ravizza, S. M., & Ciranni, M. A. (2002). Contributions of the prefrontal cortex and basal ganglia to set shifting. Journal of Cognitive Neuroscience, 14(3), 472–483.PubMedCrossRefGoogle Scholar
  63. Reeves, G., & Anthony, B. (2009). Multimodal treatments versus pharmacotherapy alone in children with psychiatric disorders: Implications of access, effectiveness, and contextual treatment. Pediatric Drugs, 11(3), 165–169.PubMedCrossRefGoogle Scholar
  64. Schoemaker, K., Bunte, T., Wiebe, S. A., Andrews, K., Deković, M., & Matthys, W. (2012). Executive function deficits in preschool children with ADHD and DBD. Journal of Child Psychology and Psychiatry and Allied Disciplines, 53, 111–119.CrossRefGoogle Scholar
  65. Seidman, L. J., Valera, E. M., & Makris, N. (2005). Structural brain imaging of attention-deficit/hyperactivity disorder. Biological Psychiatry, 57(11), 1263–1272.PubMedCrossRefGoogle Scholar
  66. Shachar, R., & Tannock, R. (1995). Test of four hypotheses for the comorbidity of attention-deficit hyperactivity disorder and conduct disorder. Journal of American Academy of Child and Adolescent Psychiatry, 34, 639–648.CrossRefGoogle Scholar
  67. Singhal, A., Shafer, A. T., Russell, M., Gibson, B., Wang, L., Vohra, S., et al. (2012). Electrophysiological correlates of fearful and sad distraction on target processing in adolescents with attention deficit-hyperactivity symptoms and affective disorders. Frontiers in Integral Neuroscience, 6, 119.Google Scholar
  68. Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., et al. (2010). Emotional liability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): Clinical correlates and familial prevalence. Journal of Child Psychology and Psychiatry and Allied Disciplines, 51, 915–923.CrossRefGoogle Scholar
  69. Spencer, T. J. (2006). ADHD and comorbidity in childhood. Journal of Clinical Psychiatry, 67(Suppl 8), 27–31.PubMedGoogle Scholar
  70. Stern, C. E., Owen, A. M., Tracey, I., Look, R. B., Rosen, B. R., & Petrides, M. (2000). Activity in ventrolateral and mid-dorsolateral prefrontal cortex during nonspatial visual working memory processing: Evidence from functional magnetic resonance imaging. Neuroimage, 11(1), 392–399.PubMedCrossRefGoogle Scholar
  71. Tamm, L., Hughes, C., Ames, L., Pickering, J., Silver, C. H., Stavinoha, P., et al. (2010). Attention training for school-aged children with ADHD: Results of an open trial. Journal of Attention Disorders, 14(1), 86–94.PubMedCrossRefGoogle Scholar
  72. Volkow, N. D., Wang, G. J., Newcorn, J. H., Kollins, S. H., Wigal, T. L., Telang, F., et al. (2011). Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathway. Molecular Psychiatry, 16, 1147–1154.PubMedCrossRefGoogle Scholar
  73. Wasserstein, J., & Lynn, A. (2001). Metacognitive remediation in adult ADHD: Treating executive function deficits via executive functions. Annals of the New York Academy of Sciences, 931(1), 376–384.PubMedCrossRefGoogle Scholar
  74. Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57(11), 1336–1346.PubMedCrossRefGoogle Scholar
  75. Wodka, E. L., Mahone, E. M., Blankner, J. G., Larson, J. C., Fotedar, S., et al. (2007). Evidence that response inhibition is a primary deficit in ADHD. Journal of Clinical and Experimental Neuropsychology, 29(4), 345–356.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.COMSATS University IslamabadLahorePakistan

Personalised recommendations