The role of executive functions in attention deficit hyperactivity disorder (ADHD) varies considerably depending on the models of ADHD. We examined the interrelationship of two major executive functions (i.e., inhibition and working memory) with behavioral, emotional, and school problems in a group of children who had a comprehensive neuropsychological evaluation. Our sample included both children with one of ADHD subtypes and a non-clinical control group. Multiple measures of executive functions were subjected to an exploratory factor analysis, resulting in three interdependent but distinguishable underlying factors: executive concept formation, working memory, and cognitive perseveration (disinhibition). A series of predictions from two recent models of ADHD (Barkley, 1997a, 1997b; Rapport, Chung, Shore, & Isaccs, 2001) were tested through hierarchical regressions. Results indicated that, although working memory and disinhibition were significantly related to teacher-reported attention problems, working memory was a mediator, but not a moderator, of the effect of disinhibition on attention problems. Working memory was related to a variety of behavioral, emotional, and school problems that are common to children with ADHD. These results were interpreted as affirming a series of predictions from the working memory model of ADHD (Rapport et al., 2001).
Get full access to this article
View all access options for this article.
References
1.
Achenbach, T.M., & Edelbrock, C. (1986a). Manual for the child behavior checklist and profile . Burlington, VT: University of Vermont, Department of Psychiatry.
2.
Achenbach, T.M., & Edelbrock, C. (1986b). Manual for the teacher report form and profile . Burlington, VT: University of Vermont, Department of Psychiatry.
3.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author .
4.
Anderson, S.W., Damasio, H., Jones, R.D., & Tramel, D. (1991). Wisconsin Card Sorting Test performance as a measure of frontal lobe functioning. Journal of Clinical and Experimental Neuropsychology,18, 909-922.
5.
Barkley, R.A. (1997a). Behavioral inhibition, sustained attention, and executive functions: Constructing a unified theory of ADHD. Psychological Bulletin, 121, 65-94.
6.
Barkley, R.A. (1997b). ADHD and the nature of self-controI. New York: Guilford.
7.
Barkley, R.A. (2000). Genetics of childhood disorders: XVII. ADHD, Part 1: The executive functions and ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1064-1068.
8.
Belmont, J.M. (1978). Individual differences in memory: The cases of normal and retarded development. In M. M. Gruneberg & P. Morris (Eds.), Aspects of memory (pp. 153-185). London: Methuen.
9.
Boone, K.B., Ponton, M.O., Gorsuch, R.L., Gonzalez, J.J., & Miller, B.L. (1998). Factor analysis of four measures of prefrontal lobe functioning. Archives of Clinical Neuropsychology, 13, 585-595.
10.
Chelune, G.J., & Baer, R.A. (1986). Developmental norms for the Wisconsin Card Sorting Test. Journal of Clinical and Experimental Neuropsychology , 8, 219-228.
11.
Cohen, J.D., & Servan-Schreiber, D. (1992). Context, cortex, and dopamine: A connectionist approach to behavior and biology in schizophrenia . Psychological Review, 99,45-47.
12.
Cohen, M.J., Morgan, A.E., Vaughn, M., Riccio, C.A., & Hall, J. (1999). Developmental differences in verbal fluency in children. Archives of Clinical Neuropsychology, 14, 433-443.
13.
Dehaene, S., & Changeux, J.P. (1991). The Wisconsin Card Sorting Test: Theoretical analysis and modeling in a neuronal network. Cerebral Cortex, 1, 62-79.
14.
Denckla, M.B. (1996). A theory and model of executive function: A neuropsychological approach. In G. R. Lyon & N.A. Krasnegor (Eds.), Attention, memory, and executive function (pp. 263-278). Baltimore: Paul H. Brookes.
15.
Denny, C.B., & Rapport, M.D. (2000). Cognitive pharmacology of stimulant drugs in AD/HD . In M. Solanto, A. F. T. Arnsten, & F. X. Castellanos (Eds.), Stimulant drugs and ADHD: Basic and clinical neuroscience (pp. 283-302). New York; Oxford University Press.
16.
Diamond, A. (1991). Guidelines for the study of brain-behavior relationships during development. In H.S. Levine, H. M., Eisenberg, & A. L. Benton. (Eds.), Frontal lobe function and dusfunction (pp. 339-378). New York: Oxford University Press.
17.
Eslinger, P.J. (1996). Conceptualizing, describing, and measuring components of executive function: A summary. In G. R. Lyon & N. A. Krasnegor (Eds.), Attention, memory, and executive function (pp. 367-396). Baltimore, MD: Paul H. Brooks.
18.
Floyd, F.J., & Widaman, K.F. (1995). Factor analysis in the development and refinement of clinical assessment instruments. Psychological Assessment , 7, 286-299.
19.
Gioia, G.A., Isquith, P.K., & Guy, S.C. (2001). Assessment of executive functions in children with neurological impairment. In R. J. Simeonsson & S. L. Rosenthal (Eds.), Psychological and developmental assessment: Children with disabilities and chronic conditions (pp. 317-356). New York: Guilford.
20.
Greve, K.W., Ingram, F., & Bianchini, K.J. (1998). Latent structure of the Wisconsin Card Sorting Test in a clinical sample. Archives of Clinical Neuropsychology, 13, 597-609.
21.
Grodzinsky, G.M., & Diamond, R. (1992). Frontal lobe functioning in boys with attention-deficit hyperactivity disorder. Developmental Neuropsychology, 8, 427-445.
Hynd, G.W., Lorys, A.R., Semrud-Clikeman, M., Nieves, N., Huettner, M., & Lahey, B.B. (1991). Attention deficit disorder without hyperactivity (ADD/ WO): A distinct behavioral and neurocognitive syndrome. Journal of Child Neurology, 6, S36-S43.
24.
Kaufman, A.S., & Kaufman, N.L. (1983). The Kaufman Assessment Battery for Children. Circle Pines, MN: American Guidance Service .
25.
Kimberg, D.Y., & Farah, M.J. (1993). A unified account of cognitive impairments following frontal lobe damage: The role of working memory in complex, organized behavior . Journal of Experimental Psychology: General, 122, 411-428.
26.
Koren, D., Seidman, L.J., Harrison, R.H., Lyons, M.J., Kremem, W.S., Caplan, B., Goldstein, J.M., Faraone, S.V., & Tsuang, M.T. (1998). Factor structure of the Wisconsin Card Sorting Test: Dimensions of deficit in schizophrenia. Neuropsychology , 12, 289-302.
27.
Lehto, J.E., Juujarvi, P., Kooistra, L., & Pulkkinen, L. (2003). Dimensions of executive functioning: Evidence from children. British Journal of Developmental Psychology , 21, 59-80.
28.
Lezak, M.D. (1995). Neuropsychological assessment. New York: Oxford University Press.
29.
Lyon, G.R., & Krasnegor, N.A. (1996). Attention, memory, and executivefunction. Baltimore, MD: Paul H. Brooks.
30.
Milner, B. (1963). Effects of different brain lesions on card sorting . Archives of Neurology, 9, 100-110.
31.
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., Howerter, A., & Wager, T.D. (2000). The unity and diversity of executive functions and their contributions to complex "frontal lobe" tasks: A latent variable analysis. Cognitive Psychology, 41, 49-100.
32.
Nigg, J.T. (2001). Is ADHD a disinhibitory disorder? Psychological Bulletin, 127, 571-598.
33.
Ozonoff, S. (1997). Components of executive function in autism and other disorders. In J. Russell (Ed.), Autism as an executive disorder (pp. 179-211). Oxford: Oxford University Press.
34.
Paolo, A.M., Troester, A.I., Axelrod, B.N., & Koller, W.C. (1995). Construct validity of the WCST in normal elderly and persons with Parkinson's disease. Archives of Clinical Neuropsychology, 10, 463-473.
35.
Passler, M.A., Isaac, W., & Hynd, G.W. (1985). Neuropsychological development of behavior attributed to frontal lobe functioning in children. Developmental Neuropsychology , 1, 349-370.
36.
Pennington, B.F. (1994). The working memory function of the prefrontal cortices: Implications for developmental and individual differences in cognition . In M. M. Haith, J. Benson,R. J. Roberts, Jr., & B. F. Pennington (Eds.), The development of future-oriented processes (pp. 243-289). Chicago: University of Chicago Press.
37.
Pennington, B.F. (1997). Dimensions of executive functions in normal and abnormal development. In N. A. Krasnegor, G. R. Lyon, & P. S. Goldman-Rakic (Eds.), Development of the prefrontal cortex: Evolution, neurobiology, and behavior (pp. 265-281). Baltimore: Brookes.
38.
Pennington, B.F., Bennetto, L., McAleer, O., & Roberts, R.J. Jr. (1996). Executive functions and working memory. In G. R. Lyon & N. A. Krasnegor (Eds.), Attention, memory, and executive functions (pp. 327-348). Baltimore: Paul H. Brookes.
39.
Pennington, B.F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology . Journal of Child Psychology and Psychiatry, 37, 51-87.
40.
Rapport, M.D., Chung, K., Shore, G., & Issacs, P. (2001). A conceptual model of child psychopathology: Implications for understanding attention deficit hyperactivity disorder and treatment efficacy . Journal of Clinical Child Psychology, 30,48-58.
41.
Reynolds, C.R., & Kamphaus, R.W. (1992). Behavior Assessment System for Children. Circle Pines, MN: American Guidance Service.
42.
Roberts, R.J., Hager, L.D., & Heron, C. (1994). Prefrontal cognitive processes: Working memory and inhibition in the anti-saccade task. Journal of Experimental Psychology: General, 123, 374-393.
43.
Roberts, R.J., & Pennington, B.F. (1996). An interactive framework for examining prefrontal cognitive processes. Developmental Neuropsychology, 12, 105-126.
44.
Schwean, V.L., & Saklofske, D.H. (1998). WISC-III assessment of children with attention deficit/hyperactivity disorder. In A. Prifitera & D. H. Saklofske (Eds.), WISC-III clinical use and interpretation (pp. 91-118). San Diego: Academic Press.
45.
Semel, E., Wiig, E., & Secord, W. (1987). Clinical evaluation of language fundamentals - Revised. San Antonio, TX: The Psychological Corporation.
46.
Stuss, D.T., & Benson, D.F. (1984). Neuropsychological studies of the frontal lobes . Psychological Bulletin, 95, 3-28.
47.
Vaughn, M.L., Riccio, C.A., Hynd, G.W., & Hall, J. (1997). Diagnosing ADHD (predominantly inattention and combined type subtypes): Discriminant validity of the Behavior Assessment System for Children and the Achenbach parent and teacher rating scales. Journal of Clinical Child Psychology, 26, 349-357.
48.
Wechsler, D. (1991). Wechsler Intelligence Scale for Children - Third Edition. San Antonio, TX: The Psychological Corporation.
49.
Weinert, F., & Kluwe, R. (1987). Metacognition, motivation, and performance. Hillsdale, NJ: Lawrence Erlbaum Associates .
50.
Welsh, M.C. (2002). Developmental and clinical variations in executive functions. In D. L. Molfese & V. J. Molfese (Eds.), Developmental variations in learning: Applications to social, executive function, language and reading skills (pp. 139-185). Mahwah, NJ:Lawrence Erlbaum Associates.
51.
Welsh, M.C., & Pennington, B.F. (1988). Assessing frontal lobe functioning in children: Views from developmental psychology. Developmental Neuropsychology, 4, 199-230.
