Executive Functioning Heterogeneity in Pediatric ADHD
Open accessAbstract
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 (BF 10 = 5.23 × 10 4), and were slightly younger (BF 10 = 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.
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Claims the paper makes
3 of 24 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
- Background
It reports that working memory impairments are found in 30% to 37% and inhibitory control deficits in 21% to 46% of pediatric ADHD cases.
“Working memory impairments are reported in 30% to 37% (Coghill et al., 2014; Fair et al., 2012), and inhibitory control deficits are detected in 21%–46% of pediatric ADHD cases (Coghill et al., 2014; Nigg et al., 2005; Solanto et al., 2001; Sonuga-Barke et al., 2010).”
Quote in the paperNot yet classified1 of 3 sources checked- cites Coghill et al., 2014 source
- cites Fair et al., 2012 source
In Results (page unavailable), Fair et al. identify two ADHD subgroups with reduced working memory, comprising 17% and 20% of their ADHD sample—37% combined. The paper does not report the 30% lower bound, so it supports only part of the cited range. Fair et al. are cited for the working-memory clause, not the separate inhibitory-control range. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites Nigg et al., 2005 source
- Background
It states that no ADHD heterogeneity study had simultaneously measured and controlled all three primary executive functions, and single-task assessments may limit conclusions.
“no study of ADHD-related heterogeneity has simultaneously measured and controlled for all three primary executive functions (Miyake et al., 2000), and conclusions may be limited by the use of single tasks to assess neurocognitive construct(s) (Conway et al., 2005).”
Quote in the paperNot yet classified1 of 3 sources checked - Background
It reports that estimates of any executive dysfunction among pediatric ADHD cases range from 21% to 60% across studies.
“estimates for the proportion of pediatric ADHD cases who exhibit any form of executive dysfunction range from 21% to 60% across studies employing a wide range of tasks and impairment criteria (Biederman et al., 2004; Coghill et al., 2014; Fair, Bathula, Nikolas, & Nigg, 2012; Geurts, van der Oord, & Crone, 2006; Nigg et al., 2005; Solanto et al., 2001; Sonuga-Barke, Bitsalou, & Thompson, 2010).”
Quote in the paperNot yet classified1 of 3 sources checked- cites Biederman et al., 2004 source
- cites Coghill et al., 2014 source
- cites Fair, Bathula, Nikolas, & Nigg, 2012 source
The introduction says that only a subset of children with ADHD may be affected on any one neuropsychological measure, and the Results identify distinct ADHD subgroups. But the Results’ 21% refers to one subgroup with relatively high reaction-time variability; the paper does not report a 21%–60% range for any executive dysfunction across studies or impairment criteria. Page numbers were not available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measured
- Finding
An oblique factor solution, allowing covariation among EF estimates, yielded 84% of the ADHD group meeting impairment criteria.
“Highly similar results were also obtained when allowing covariation among the three executive functioning estimates by specifying an oblique rather than orthogonal factor solution (84% of ADHD sample classified as impaired; sensitivity = 83.64% [71.20, 92.23], specificity = 81.48% [73.30, 89.25]).”
Quote in the paperNot yet classified - Finding
About half of the ADHD children were impaired on one executive function, while 31% were impaired on two and 4% on all three.
“Approximately half of the children with ADHD showed impairment on a single executive function (54%), and an additional third showed impairments on two (31%) or all three (4%) executive functions.”
Quote in the paperNot yet classified
- Finding
The study classified 89% of the ADHD sample as impaired on one or more executive function components.
“89% of children with ADHD were classified as Impaired on at least one executive function component (n = 49 of 55).”
Quote in the paperNot yet classified - Finding
After residualizing age, gender, and SES, 82% of the ADHD group met impairment criteria.
“Highly similar results were also obtained when controlling for age, gender, and SES by residualizing for these variables and then re-computing impairment estimates (82% of ADHD sample classified as impaired; sensitivity = 81.82% [69.10, 90.92], specificity = 80.25% [69.91, 88.27]).”
Quote in the paperNot yet classified - Finding
Domain-specific impairment rates were 62% for working memory, 27% for inhibitory control, and 38% for set shifting.
“Within specific executive function domains, 62% of children with ADHD were classified as Impaired in working memory (ORlog = 2.62), 27% Impaired in inhibitory control (ORlog = 1.49), and 38% Impaired in set shifting (ORlog = 2.36).”
Quote in the paperNot yet classified - Finding
Children with impaired working memory had significantly higher ADHD symptoms than those with unimpaired working memory.
“Results indicated significantly higher ADHD symptoms for children with impaired working memory (n=37) relative to children with unimpaired working memory (n=59) (BF10 = 5.23 x 104, d=0.36).”
Quote in the paperNot yet classified - Finding
There was significant evidence against ADHD symptom differences between children with and without impaired inhibitory control.
“Results indicated significant evidence against ADHD symptom differences for children with impaired inhibitory control (n=19) relative to children with unimpaired inhibitory control (n=77) (BF01 = 5.80, d=0.04).”
Quote in the paperNot yet classified - Finding
The working-memory-impaired subgroup was slightly younger than the subgroup without such impairment.
“Children with working memory impairment (Mage = 9.91, SD = 1.41) were slightly younger than children without working memory impairment (Mage = 10.82, SD = 1.45) (BF10 = 11.35, d=0.64).”
Quote in the paperNot yet classified - Finding
There was significant evidence against ADHD symptom differences between children with and without impaired set shifting.
“Results indicated significant evidence against ADHD symptom differences for children with impaired set shifting (n=24) relative to children with unimpaired set shifting (n=72) (BF01 = 7.34, d=0.02).”
Quote in the paperNot yet classified - Finding
A one-factor executive functioning solution showed high specificity but poor sensitivity, supporting heterogeneity across executive function domains.
“This overall estimate of executive functioning showed high specificity (98.77% [93.31, 99.97]) but poor sensitivity (34.55% [22.24, 48.58]), supporting ADHD-related heterogeneity across executive function domains.”
Quote in the paperNot yet classified - Finding
Just 11% of the ADHD group was unimpaired across all three executive functions.
“Only 11% (6 of 55) of children with ADHD were classified as Not Impaired on all three executive functions.”
Quote in the paperNot yet classified - Finding
With a 10th-percentile cutoff, 91% of the ADHD sample met impairment criteria for one or more executive functions.
“defining impairment as the 10th percentile of the Non-ADHD group resulted in 91% of ADHD children being classified as Impaired on at least one executive function (n=50 of 55; sensitivity = 90.91% [80.05, 96.98], specificity = 75.31% [64.47, 84.22]).”
Quote in the paperNot yet classified - Finding
The ADHD group showed group-level impairments relative to the non-ADHD group in working memory, inhibitory control, and set shifting.
“The ADHD group demonstrated group-level impairments in working memory (d = 1.41; BF10 = 1.64 x 1010), inhibitory control (d= 0.60; BF10 = 33.51), and set shifting (d = 0.46; BF10 = 4.29) relative to the Non-ADHD group.”
Quote in the paperNot yet classified - Background
It argues that conclusions about limited executive dysfunction in ADHD may be premature because much of the evidence comes from clinical tests designed to detect gross neurological impairment rather than subtle cognitive-control deficits.
“these conclusions may be premature because the evidence-base is comprised, in large part, on data from clinical tests developed to detect gross neurological impairment rather than the more subtle deficits in cognitive control hypothesized to underlie the ADHD phenotype.”
Quote in the paperNot yet classified0 of 1 sources checked- cites Sonuga-Barke et al. (2008) source
- Background
It describes the task impurity problem: no task is process-pure, and specificity conclusions are constrained unless correlated but distinct abilities are measured and controlled.
“no task is process pure (Shipstead, Redick, & Engle, 2010): all tasks require multiple executive and non-executive neurocognitive abilities for successful performance, and conclusions regarding effect specificity are limited when these correlated but distinct abilities are not measured and simultaneously controlled (Miyake & Friedman, 2012).”
Quote in the paperNot yet classified0 of 2 sources checked - Background
It reports that factor-analytic and theoretical evidence best supports a model with three main executive function domains: working memory, inhibitory control, and set shifting.
“factor analytic and theoretical work provides the most empirical support for models that include three primary executive function domains: working memory, inhibitory control, and set shifting (Miyake et al., 2000; Miyake & Friedman, 2012; St. Clair-Thompson & Gathercole, 2006; Van der Molen et al., 2006; Van der Sluis et al., 2007).”
Quote in the paperNot yet classified0 of 3 sources checked - Background
The paper defines executive functions as interrelated higher-order cognitive processes that allow goal-directed behavior and novel problem solving.
“Executive functions refer to a set of interrelated, higher-order cognitive processes that enable goal directed behavior and novel problem solving (Baddeley, 2007; Miyake et al., 2000).”
Quote in the paperNot yet classified0 of 2 sources checked - Background
It states that no ADHD study had examined set shifting heterogeneity, but meta-analytic effect sizes predict that 30% to 36% of children with ADHD may show set shifting impairments.
“meta-analytic effect sizes of d=0.46 to 0.55 (Willcutt et al., 2005) predict that 30%–36% of children with ADHD may demonstrate set shifting impairments based on converting effect size differences into expected population overlap proportions (Zakzanis et al., 2001).”
Quote in the paperNot yet classified0 of 2 sources checked - Background
It cites meta-regression showing that working memory deficit estimates in ADHD rose from medium to very large when tasks had a prominent executive component.
“Using meta-regression, they found that their estimate of working memory deficits in ADHD increased from medium to very large (d=2.0–2.2) when based on working memory tasks with a prominent executive component congruent with contemporary cognitive definitions.”
Quote in the paperNot yet classified0 of 1 sources checked- cites Kasper et al., 2012 source
- Background
It reports that meta-analyses show medium-to-large group-level working memory and inhibitory control impairments in pediatric ADHD.
“Working memory and inhibitory control have been studied extensively in pediatric ADHD, with meta-analyses indicating medium to large group-level impairments on tasks intended to assess these executive functions (Alderson et al., 2007; Kasper et al., 2012; Lijffijt et al., 2005; Martinussen et al., 2005; Willcutt et al., 2005).”
Quote in the paperNot yet classified0 of 3 sources checked - Background
It notes that only a small proportion of ADHD cases have been classified as impaired on more than one executive function test.
“only a minority of ADHD cases are classified as impaired on multiple executive function tests (Biederman et al., 2004)”
Quote in the paperNot yet classified0 of 1 sources checked- cites Biederman et al., 2004 source
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Results indicated that children with ADHD have large working memory deficits and medium-to-null inhibitory control and set shifting deficits relative to children without ADHD.
“Results indicated that children with ADHD have large working memory deficits and medium-to-null inhibitory control and set shifting deficits relative to children without ADHD.51,53,56,58,75”
From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [51]
The Results (Tier 1: Executive Functioning Impairments in ADHD; page unavailable) report more frequent working-memory impairment (62%) than inhibitory-control (27%) or set-shifting impairment (38%) among children with ADHD, using the non-ADHD group as the reference. This supports the relative pattern, but those percentages do not establish the claimed large versus medium-to-null magnitudes of the group differences. (LLM, conf=0.83)
Experimental — accuracy not yet measuredA series of studies by some of the authors included children with ADHD and ASD, controlled for ASD when evaluating executive functions in ADHD, and used a battery of construct-valid working memory tests.
“a series of studies by some of the authors of the current Review included children with ADHD and ASD, controlled for ASD when evaluating executive functions in ADHD, and used a battery of construct-valid working memory tests.”
From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [51]
The Method (Group Assignment; page unavailable) includes children with ASD in both the ADHD and non-ADHD groups and reports the same ASD rate (5%) in each. The Current Study and Method (Measures; pages unavailable) describe a battery with multiple criterion tests, including validated working-memory tasks. This paper describes one study, not a series, and its ASD control was through group composition rather than a reported ASD-specific statistical adjustment. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOnly 17% of children with ADHD have impairments in both inhibition and working memory, vs. 46% who have working memory but not inhibition deficits, and only 11% who have inhibition deficits but not working memory deficits.
“Similarly, Kofler et al. (9) reported that only 17% of children with ADHD have impairments in both inhibition and working memory (vs. 46% who have working memory but not inhibition deficits, and only 11% who have inhibition deficits but not working memory deficits).”
From Working memory and inhibitory control deficits in children with ADHD: an experimental evaluation of competing model predictions (2024) · cites this paper as [9]
The Results (Tier 1: Executive Functioning Impairments in ADHD; page unavailable) report that 62% of children with ADHD had working-memory impairment and 27% had inhibitory-control impairment, supporting the general pattern that working-memory deficits were more common. Our copy does not give the claimed 17% overlap, 46% working-memory-only, or 11% inhibition-only breakdown; the reported marginal rates cannot establish those joint percentages. (LLM, conf=0.80)
Experimental — accuracy not yet measuredThe finding is consistent with evidence that only 5-11% of children with ADHD have inhibition deficits without co-occurring working memory deficits.
“Although these effect sizes are not directly comparable because they reflect performance changes vs. between group differences, this finding is consistent with evidence that only 5-11% of children with ADHD have inhibition deficits without co-occurring working memory deficits (9, 74) and calls into question the extent to which children with ADHD have deficits in inhibitory control versus perform”
From Working memory and inhibitory control deficits in children with ADHD: an experimental evaluation of competing model predictions (2024) · cites this paper as [9]
The Results (Tier 1: Executive Functioning Impairments in ADHD; page unavailable) report inhibitory-control deficits in 27% of children with ADHD and working-memory deficits in 62%. They do not report how many had inhibition deficits without co-occurring working-memory deficits, so the cited paper does not establish the claimed 5–11% range. Its 11% figure refers instead to children unimpaired on all three executive functions. (LLM, conf=0.83)
Experimental — accuracy not yet measuredRecent heterogeneity studies classified 62%-85% of children with ADHD as impaired in working memory.
“Furthermore, highly similar results were reported in recent heterogeneity studies reporting that 62%−85% of children with ADHD were classified as impaired in working memory (Fosco et al., in press; Karalunas et al., 2017; Kofler, Irwin et al., 2019).”
From Working memory and short-term memory deficits in ADHD: A bifactor modeling approach (2020) · cites this paper as Kofler, Irwin et al., 2019
There is a subtype-specific cognitive profile, measured by WISC-IV, in ADHD, confirming cognitive heterogeneity in ADHD.
“Taken together, the results of the present study show that there is subtype-specific cognitive profile, measured by WISC-IV, in ADHD confirming a cognitive heterogeneity in ADHD in line with recent evidence [48].”
From ADHD subtype-specific cognitive correlates and association with self-esteem: a quantitative difference (2020) · cites this paper as [48]
A recent study found a positive association between impaired working memory and exhibiting higher ADHD symptoms.
“A recent study that comprehensively examined executive functioning heterogeneity in pediatric ADHD using neuropsychological battery also found a positive association between impaired working memory and exhibiting higher ADHD symptoms [48].”
From ADHD subtype-specific cognitive correlates and association with self-esteem: a quantitative difference (2020) · cites this paper as [48]
Together, these findings suggest that only a small minority of children with ADHD have impairments in both working memory and inhibitory control, and thus appear to support models conceptualizing them as relatively independent impairments in ADHD.
“Together, these findings suggest that only a small minority of children with ADHD have impairments in both working memory and inhibitory control, and thus appear to support models conceptualizing them as relatively independent impairments in ADHD.”
From Working memory and inhibitory control deficits in children with ADHD: an experimental evaluation of competing model predictions (2024) · cites this paper as [9]
ADHD inattention symptoms are consistently linked with daily life executive functioning deficits, neuropsychological indicators of executive functioning difficulties, and academic impairment.
“and are consistently linked with daily life executive functioning deficits (Becker et al., 2011), neuropsychological indicators of executive functioning difficulties (Kofler et al., 2019), and academic impairment (Dvorsky & Langberg, 2019).”
From Disentangling the effects of attentional difficulties on fears of social evaluation and social anxiety symptoms: Unique interactions with sluggish cognitive tempo (2020) · cites this paper as Kofler et al., 2019
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Ethnicity counts omit five participants
MinorThe ethnicity categories total 131 children, but the stated sample contains 136. The text does not identify an ethnicity category or missing ethnicity data for the other five children.
Reported 136 · recomputed 131
“Sample ethnicity was mixed with 81 Caucasian Non-Hispanic (62%), 16 African American (12%), 14 Hispanic (11%), 13 multiracial children (10%), and 7 Asian (5%) children.”
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Bayesian Benefits for the Pragmatic Researcher
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A Bayesian perspective on the bonferroni adjustment
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Complex span and n-back measures of working memory: A meta-analysis
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“For example, evidence from carefully controlled experimental studies suggests that ADHD-related inattentive and hyperactive behavior can be produced and rarefied by manipulating working memory demands (Hudec et al. 2015; Kofler et al. 2010; Rapport et al. 2009), whereas similar manipulations of inhibition demands have…”
BackgroundInfluentialSelf-citationAssessing inattention and impulsivity in children during the Go/NoGo task
Bezdjian, S., Baker, L. A., Lozano, D. I., & Raine, A. (2009) · British Journal of Developmental Psychology · doi:10.1348/026151008x314919 · Cited by 263 · see citing works
Does working memory training generalize?
Shipstead, Z., Redick, T. S., & Engle, R. W. (2010) · Psychologica Belgica · doi:10.5334/pb-50-3-4-245 · Cited by 242 · see citing works
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“…without ADHD at similar rates as parent and teacher ADHD rating scales (Tarle et al. 2017), and predict hyperactivity (Rapport et al. 2009), attention (Kofler et al. 2010), impulsivity (Raiker et al. 2012), and ADHD-related functional impairments (Friedman et al. 2017; Kofler et al. 2011, 2016).”
BackgroundInfluentialSelf-citationSensitivity of psychiatric diagnosis based on the best estimate procedure
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Working Memory Deficits and Social Problems in Children with ADHD
Kofler, M. J., Rapport, M. D., Bolden, J., Sarver, D. E., Raiker, J. S., & Alderson, R. M. (2011) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-011-9492-8 · Cited by 227 · cited 1× · see citing works
“…without ADHD at similar rates as parent and teacher ADHD rating scales (Tarle et al. 2017), and predict hyperactivity (Rapport et al. 2009), attention (Kofler et al. 2010), impulsivity (Raiker et al. 2012), and ADHD-related functional impairments (Friedman et al. 2017; Kofler et al. 2011, 2016).”
BackgroundSelf-citationADHD Rating Scale-5 for Children and Adolescents: Checklists, Norms, and Clinical Interpretation
Zakeri, L. R. (2017) · School social work journal · Cited by 171 · see citing works
Sarver, D. E., Rapport, M. D., Kofler, M. J., Raiker, J. S., & Friedman, L. M. (2015) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-015-0011-1 · Cited by 149 · cited 5× · see citing works
“…memory, inhibitory control, and set shifting were derived, and these participant-level component scores were subjected to reliable change analyses (Jacobson and Truax 1991) that explicitly account for measurement error to objectively define impairment (Kofler et al. 2016; Sarver et al. 2015).”
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Valo, S., & Tannock, R. (2010) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2010.517172 · Cited by 142 · see citing works
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Raiker, J. S., Rapport, M. D., Kofler, M. J., & Sarver, D. E. (2012) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-011-9607-2 · Cited by 135 · see citing works
Self-citationDoes neurocognitive functioning predict future or persistence of ADHD? A systematic review
van Lieshout, M., Luman, M., Buitelaar, J., Rommelse, N. N. J., & Oosterlaan, J. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.02.003 · Cited by 133 · see citing works
Working memory and organizational skills problems in <scp>ADHD</scp>
Kofler, M. J., Sarver, D. E., Harmon, S. L., Moltisanti, A., Aduen, P. A., Soto, E. F., & Ferretti, N. (2018) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12773 · Cited by 125 · see citing works
Self-citationSoreni, N., Crosbie, J., Ickowicz, A., & Schachar, R. (2009) · Journal of Attention Disorders · doi:10.1177/1087054708326110 · Cited by 121 · see citing works
Measuring executive function in early childhood: A case for formative measurement.
Willoughby, M. T., The Family Life Project Investigators, & Blair, C. B. (2016) · Psychological Assessment · doi:10.1037/pas0000152 · Cited by 120 · see citing works
Whither causal models in the neuroscience of ADHD?
Coghill, D., Nigg, J., Rothenberger, A., Sonuga‐Barke, E., & Tannock, R. (2005) · Developmental Science · doi:10.1111/j.1467-7687.2005.00397.x · Cited by 116 · see citing works
Hot and cool aspects of cognitive control in children with ADHD: Decision-making and inhibition
Geurts, H. M., van der Oord, S., & Crone, E. A. (2006) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-006-9059-2 · Cited by 111 · see citing works
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Karalunas, S. L., Gustafsson, H. C., Dieckmann, N. F., Tipsord, J., Mitchell, S. H., & Nigg, J. T. (2017) · Journal of Abnormal Psychology · doi:10.1037/abn0000292 · Cited by 104 · see citing works
ADHD Rating Scale―5 for Children and Adolescents: Checklists, Norms, and Clinical Interpretation
DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. R. (2016) · Cited by 98 · see citing works
Heterogeneity in ADHD: Neurocognitive predictors of peer, family, and academic functioning
Kofler, M. J., Sarver, D. E., Spiegel, J. A., Day, T. N., Harmon, S. L., & Wells, E. L. (2017) · Child Neuropsychology · doi:10.1080/09297049.2016.1205010 · Cited by 94 · cited 11× · see citing works
“…Snyder et al. 2015) question the veracity of these estimates, such that our understanding of executive functioning in ADHD is based, in large part, on data from single tasks that may suboptimally assess their intended construct (Kofler et al. 2016; Coghill et al. 2014; SonugaBarke et al. 2008).”
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Self-citationADHD and Behavioral Inhibition: A Re-examination of the Stop-signal Task
Alderson, R. M., Rapport, M. D., Sarver, D. E., & Kofler, M. J. (2008) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-008-9230-z · Cited by 87 · cited 1× · see citing works
“Stop-signal Task and administration instructions were identical to Alderson et al. (2008).”
BackgroundSelf-citationBipolar and ADHD comorbidity: Both artifact and outgrowth of shared mechanisms.
Youngstrom, E. A., Arnold, L. E., & Frazier, T. W. (2010) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2010.01226.x · Cited by 85 · see citing works
Wells, E. L., Kofler, M. J., Soto, E. F., Schaefer, H. S., & Sarver, D. E. (2018) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2017.10.024 · Cited by 84 · cited 3× · see citing works
“…and validity evidence includes internal consistency (α = 0.82–0.97; Kofler et al. 2017), 1- to 3-week test-retest reliability (0.76–0.90; Sarver et al. 2015), and expected magnitude relations with criterion working memory complex span (r = 0.69) and updating tasks (r = 0.61) (Wells et al. 2018).”
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Self-citationKofler, M. J., Alderson, R. M., Raiker, J. S., Bolden, J., Sarver, D. E., & Rapport, M. D. (2014) · Neuropsychology · doi:10.1037/neu0000050 · Cited by 67 · cited 2× · see citing works
“Although process analysis suggests that poor performance on tests of delay aversion (Patros et al. 2015), response variability (Kofler et al. 2014), and emotion dysregulation (van Cauwenberge et al. 2015) by children with ADHD may be parsimoniously explained by associations with executive…”
BackgroundSelf-citationFriedman, L. M., Rapport, M. D., Raiker, J. S., Orban, S. A., & Eckrich, S. J. (2016) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-016-0171-7 · Cited by 63 · see citing works
Following instructions from working memory: Why does action at encoding and recall help?
Graham, A. J., Gathercole, S. E., Allen, R. J., & Holmes, J. (2016) · Memory & Cognition · doi:10.3758/s13421-016-0636-5 · Cited by 57 · see citing works
Working memory capacity and intra-individual variability of proactive control
Wiemers, E. A., & Redick, T. S. (2018) · Acta Psychologica · doi:10.1016/j.actpsy.2017.11.002 · Cited by 56 · see citing works
Patros, C. H. G., Alderson, R. M., Lea, S. E., Tarle, S. J., Kasper, L. J., & Hudec, K. L. (2015) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2014.12.016 · Cited by 43 · see citing works
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Research works printed but not linked: 2
- Kofler, M. J., Sarver, D. E., Harmon, S. L., Moltisanti, A., Aduen, P. A., Soto, E. F., & Ferretti, N. (2017). Working memory and organizational skills problems in ADHD. Journal of Child Psychology and Psychiatry.
- Sattler, J., Dumont, R., & Coalson, D. (2016). Assessment of Children: WISC-V and WPPSI-IV. San Diego: Sattler Press.
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Annual Research Review: The transdiagnostic revolution in neurodevelopmental disorders
Astle, D. E., Holmes, J., Kievit, R., & Gathercole, S. E. (2022) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13481 · Cited by 384 · see citing works
Kaiser, A., Aggensteiner, P.-M., Baumeister, S., Holz, N. E., Banaschewski, T., & Brandeis, D. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.01.019 · Cited by 171 · see citing works
Christiansen, L., Beck, M. M., Bilenberg, N., Wienecke, J., Astrup, A. V., & Lundbye‐Jensen, J. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8060841 · Cited by 148 · see citing works
Executive functioning rating scales: Ecologically valid or construct invalid?
Soto, E. F., Kofler, M. J., Singh, L. J., Wells, E. L., Irwin, L. N., Groves, N. B., & Miller, C. E. (2020) · Neuropsychology · doi:10.1037/neu0000681 · Cited by 115 · see citing works
“Reliability and validity evidence includes high internal consistency (α = .81–.97) and 1–3-week test-retest reliability (.76–.90; Kofler et al., 2019; Sarver et al., 2015), and expected relations with criterion working memory complex span (r = .69) and updating tasks (r = .61) (Wells et al., 2018).”
BackgroundMethodInfluentialSelf-citationExecutive Functioning and Emotion Regulation in Children with and without ADHD
Groves, N. B., Wells, E. L., Soto, E. F., Marsh, C. L., Jaisle, E. M., Harvey, T. K., & Kofler, M. J. (2022) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-021-00883-0 · Cited by 110 · see citing works
Self-citationWorking memory and short-term memory deficits in ADHD: A bifactor modeling approach
Kofler, M. J., Singh, L. J., Soto, E. F., Chan, E. S. M., Miller, C. E., Harmon, S. L., & Spiegel, J. A. (2020) · Neuropsychology · doi:10.1037/neu0000641 · Cited by 101 · see citing works
“, 2005), identifying neurocognitive components that are intact in pediatric ADHD is important for improving our understanding of the mechanisms and processes that underlie – and do not underlie – the disorder’s heterogeneous behavioral presentation (Kofler et al., 2019).”
BackgroundSelf-citationPhysical Activity and Mental Health in Children and Adolescents With Neurodevelopmental Disorders
Liu, C., Liang, X., & Sit, C. H. P. (2024) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2023.6251 · Cited by 92 · see citing works
An Examination of Relations Among Working Memory, ADHD Symptoms, and Emotion Regulation
Groves, N. B., Kofler, M. J., Wells, E. L., Day, T. N., & Chan, E. S. M. (2020) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-019-00612-8 · Cited by 75 · see citing works
Self-citationWhat cognitive processes are “sluggish” in sluggish cognitive tempo?
Kofler, M. J., Irwin, L. N., Sarver, D. E., Fosco, W. D., Miller, C. E., Spiegel, J. A., & Becker, S. P. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000446 · Cited by 61 · see citing works
Self-citationLudyga, S., Mücke, M., Leuenberger, R., Bruggisser, F., Pühse, U., Gerber, M., Mori, A. C., Keutler, C., Brotzmann, M., & Weber, P. (2022) · NeuroImage Clinical · doi:10.1016/j.nicl.2022.103156 · Cited by 74 · see citing works
Do children with attention-deficit/hyperactivity disorder (ADHD) have set shifting deficits?
Irwin, L. N., Kofler, M. J., Soto, E. F., & Groves, N. B. (2019) · Neuropsychology · doi:10.1037/neu0000546 · Cited by 54 · see citing works
Self-citationExecutive functions and writing skills in children with and without ADHD.
Soto, E. F., Irwin, L. N., Chan, E. S. M., Spiegel, J. A., & Kofler, M. J. (2021) · Neuropsychology · doi:10.1037/neu0000769 · Cited by 60 · see citing works
Self-citationWhich ‘Working’ Components of Working Memory aren’t Working in Youth with ADHD?
Fosco, W. D., Kofler, M. J., Groves, N. B., Chan, E. S. M., & Raiker, J. S. (2020) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-020-00621-y · Cited by 55 · see citing works
Self-citationChronic Exercise for Core Symptoms and Executive Functions in ADHD: A Meta-analysis
Huang, H., Jin, Z., He, C., Guo, S., Zhang, Y., & Quan, M. (2022) · PEDIATRICS · doi:10.1542/peds.2022-057745 · Cited by 56 · see citing works
Molavi, P., Nadermohammadi, M., Salvat Ghojehbeiglou, H., Vicario, C. M., Nitsche, M. A., & Salehinejad, M. A. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02887-4 · Cited by 51 · see citing works
“Taken together, the results of the present study show that there is subtype-specific cognitive profile, measured by WISC-IV, in ADHD confirming a cognitive heterogeneity in ADHD in line with recent evidence [48].”
BackgroundResultSong, Y., Fan, B., Wang, C., & Yu, H. (2023) · PLOS ONE · doi:10.1371/journal.pone.0289732 · Cited by 50 · see citing works
Ren, F.-F., Chen, F., Zhou, W.-S., Cho, Y.-M., Ho, T., Hung, T., & Chang, Y. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.656141 · Cited by 41 · see citing works
Kofler, M. J., Wells, E. L., Singh, L. J., Soto, E. F., Irwin, L. N., Groves, N. B., Chan, E. S. M., Miller, C. E., Richmond, K. P., Schatschneider, C., et al. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000550 · Cited by 44 · see citing works
Self-citationExecutive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder
Kofler, M. J., Soto, E. F., Singh, L. J., Harmon, S. L., Jaisle, E. M., Smith, J. N., Feeney, K. E., & Musser, E. D. (2024) · Nature Reviews Psychology · doi:10.1038/s44159-024-00350-9 · Cited by 51 · see citing works
Self-citationFosco, W. D., Kofler, M. J., Alderson, R. M., Tarle, S. J., Raiker, J. S., & Sarver, D. E. (2019) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-018-0504-9 · Cited by 42 · see citing works
Self-citationAre There Resilient Children with ADHD?
Chan, E. S. M., Groves, N. B., Marsh, C. L., Miller, C., Richmond, K. P., & Kofler, M. J. (2021) · Journal of Attention Disorders · doi:10.1177/10870547211025629 · Cited by 40 · see citing works
Self-citationIrwin, L. N., Soto, E. F., Chan, E. S. M., Miller, C. E., Carrington-Forde, S., Groves, N. B., & Kofler, M. J. (2021) · Child Neuropsychology · doi:10.1080/09297049.2020.1866521 · Cited by 39 · see citing works
“However, given the well documented heterogeneity of executive functioning among children with ADHD (Castellanos & Tannock, 2002; Kofler et al., 2019), it will be important for future work to consider the unique contributions of each executive function in addition to working memory as they relate to children’s performa…”
BackgroundInfluentialSelf-citationIsfandnia, F., El Masri, S., Radua, J., & Rubia, K. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105703 · Cited by 36 · see citing works
Arnett, A. B., Peisch, V. D., & Levin, A. R. (2022) · Journal of Neurophysiology · doi:10.1152/jn.00295.2022 · Cited by 29 · see citing works
Neurophysiological markers of ADHD symptoms in typically-developing children
Hilger, K., Sassenhagen, J., Kühnhausen, J., Reuter, M., Schwarz, U., Gawrilow, C., & Fiebach, C. J. (2020) · Scientific Reports · doi:10.1038/s41598-020-80562-0 · Cited by 35 · see citing works
Breitling-Ziegler, C., Zaehle, T., Wellnhofer, C., Dannhauer, M., Tegelbeckers, J., Baumann, V., Flechtner, H., & Krauel, K. (2021) · Progress in brain research · doi:10.1016/bs.pbr.2021.01.014 · Cited by 32 · see citing works
The Efficacy of Cognitive Videogame Training for ADHD and What FDA Clearance Means for Clinicians
Evans, S. W., Beauchaine, T. P., Chronis-Tuscano, A., Becker, S. P., Chacko, A., Gallagher, R., Hartung, C. M., Kofler, M. J., Schultz, B. K., Tamm, L., et al. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2020.1859960 · Cited by 32 · see citing works
Self-citationKofler, M. J., Groves, N. B., Chan, E. S. M., Marsh, C. L., Cole, A. M., Gaye, F., Cibrian, E., Tatsuki, M. O., & Singh, L. J. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1277583 · Cited by 35 · see citing works
Self-citationSchool Readiness in Preschoolers With Symptoms of Attention-Deficit/Hyperactivity Disorder
Perrin, H. T., Heller, N. A., & Loe, I. M. (2019) · PEDIATRICS · doi:10.1542/peds.2019-0038 · Cited by 34 · see citing works
Sibbick, E., Boat, R., Sarkar, M., Groom, M. J., & Cooper, S. B. (2022) · Mental health and physical activity · doi:10.1016/j.mhpa.2022.100469 · Cited by 30 · see citing works
Wu, Z.-M., Wang, P., Liu, L., Liu, J., Cao, X., Sun, L., Cao, Q., Yang, L., Wang, Y., & Yang, B. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.02.012 · Cited by 31 · see citing works
Rosenau, P. T., Openneer, T. J. C., Matthijssen, A. M., van de Loo-Neus, G. H. H., Buitelaar, J. K., van den Hoofdakker, B. J., Hoekstra, P. J., & Dietrich, A. (2021) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13419 · Cited by 26 · see citing works
The (Un)real Existence of ADHD—Criteria, Functions, and Forms of the Diagnostic Entity
Honkasilta, J., & Koutsoklenis, A. (2022) · Frontiers in Sociology · doi:10.3389/fsoc.2022.814763 · Cited by 29 · see citing works
Schwörer, M. C., Reinelt, T., Petermann, F., & Petermann, U. (2020) · Quality of Life Research · doi:10.1007/s11136-019-02394-4 · Cited by 27 · see citing works
Tracking Inhibitory Control in Youth With ADHD: A Multi-Modal Neuroimaging Approach
Tremblay, L. K., Hammill, C. F., Ameis, S. H., Bhaijiwala, M., Mabbott, D., Anagnostou, E. A., Lerch, J. P., & Schachar, R. J. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00831 · Cited by 25 · see citing works
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Calub, C. A., Rapport, M. D., Friedman, L. M., & Eckrich, S. J. (2019) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-019-09728-z · Cited by 24 · see citing works
Rojo-Marticella, M., Arija, V., & Canals, J. (2025) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-024-01278-7 · Cited by 26 · see citing works
Neural basis of working memory in ADHD: Load versus complexity
Mukherjee, P., Hartanto, T. A., Iosif, A., Dixon, J. F., Hinshaw, S. P., Pakyürek, M., van den Bos, W., Guyer, A. E., McClure, S. M., Schweitzer, J. B., et al. (2021) · NeuroImage Clinical · doi:10.1016/j.nicl.2021.102662 · Cited by 24 · see citing works
Baseline performance moderates stimulant effects on cognition in youth with ADHD.
Fosco, W. D., Rosch, K. S., Waxmonsky, J. G., Pelham, W. E., & Hawk, L. W. (2020) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000374 · Cited by 21 · see citing works
Cross-sectional and prospective associations of P300, RewP, and ADHD symptoms in female adolescents
Kallen, A. M., Perkins, E. R., Klawohn, J., & Hajcak, G. (2020) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2020.08.017 · Cited by 22 · see citing works
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- Authors
- Kofler, M. J., Irwin, L. N., Soto, E. F., Groves, N. B., Harmon, S. L., & Sarver, D. E.
- Affiliations
- Florida State University (US)
- University of Mississippi Medical Center (US)
- Corresponding author
- Kofler, Michael J.
- ORCID
- Venue
- Journal of Abnormal Child Psychology
- Published
- 2018-04-28
- Volume
- 47
- Issue
- 2
- Pages
- 273-286
- ISSN
- 0091-0627 (ISSN-L)
- 1573-2835
- PMC
- PMC6204311
- OpenAlex
- W2799310259
- Cited by
- 288
- References
- 94
- Citations by year
- 2026: 48 · 2025: 45 · 2024: 45 · 2023: 39 · 2022: 38 · 2021: 31 · 2020: 29 · 2019: 10 · 2018: 3
- FWCI
- 14.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Research on Child and Adolescent Psychopathology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34 MH102499)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- attention deficit hyperactivity disorder, executive function, working memory, inhibitory control, set-shifting, executive dysfunction, diagnostic criteria, inattentive symptoms, hyperactive-impulsive symptoms, children
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Inhibition, Psychological, Male, Memory, Short-Term, Neuropsychological Tests, Executive Function
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