Assessing Inhibitory Control Deficits in Adult ADHD: A Systematic Review and Meta-analysis of the Stop-signal Task
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Abstract
Abstract In recent years, there has been an increasing quest in improving our understanding of the neurocognitive deficits underlying adult attention-deficit/hyperactivity disorder (ADHD). Current statistical manuals of psychiatric disorders emphasize inattention and hyperactivity-impulsivity symptoms, but empirical studies have also shown consistent alterations in inhibitory control. To date, there is no established neuropsychological test to assess inhibitory control deficits in adult ADHD. A common paradigm for assessing response inhibition is the stop-signal task (SST). Following PRISMA-selection criteria, our systematic review and meta-analysis integrated the findings of 26 publications with 27 studies examining the SST in adult ADHD. The meta-analysis, which included 883 patients with adult ADHD and 916 control participants, revealed reliable inhibitory control deficits, as expressed in prolonged SST response times, with a moderate effect size $$g$$ g = 0.51 (95% CI: 0.376–0.644, $$p$$ p < 0.0001). The deficits were not moderated by study quality, sample characteristics or clinical parameters, suggesting that they may be a phenotype in this disorder. The analyses of secondary outcome measures revealed greater SST omission errors and reduced go accuracy in patients, indicative of altered sustained attention. However, only few ( N < 10) studies were available for these measures. Our meta-analysis suggests that the SST, in conjunction with other tests and questionnaires, could become a valuable tool for assessing inhibitory control deficits in adult ADHD.
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Deficits in adult ADHD are frequently observed in sustained and divided attention, planning and set-shifting, response inhibition, and interference control.
“Deficits are frequently observed in sustained and divided attention, planning and set-shifting (e.g., Tower of London), response inhibition (e.g., Continuous Performance Test), and interference control (e.g., Stroop) [92,93,96].”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [93]
The Abstract reports reliable response-inhibition deficits in adults with ADHD and secondary measures indicative of altered sustained attention; the Discussion also describes evidence of sustained-attention difficulties. The passages do not establish frequent deficits in divided attention, planning, set-shifting, or interference control, so the source supports only part of the attributed list. No page numbers are available in our copy. (LLM, conf=0.89)
Experimental — accuracy not yet measuredAs a group, adults with ADHD perform worse than non-clinical controls on tasks assessing executive functions.
“Empirical evidence from neuropsychological testing confirms that, as a group, adults with ADHD perform worse than non-clinical controls on tasks assessing these functions.”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [93]
The Discussion reports that adults with ADHD performed worse than controls on the stop-signal task, showing a moderate deficit in inhibitory control. That supports the group comparison for one executive function, but the paper does not establish poorer performance across tasks assessing executive functions generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCore attentional and organizational difficulties in ADHD are widely implicated as deficits in executive functions.
“The core attentional and organizational difficulties in ADHD are widely implicated as deficits in executive functions (EFs)”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [93]
The Introduction describes inattention as a symptom of adult ADHD and reports altered executive functions, particularly inhibitory control. It does not address organizational difficulties or specifically link those difficulties to executive-function deficits. No page number is available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAdults exhibiting multiple executive function impairments often report greater academic and occupational difficulties.
“adults exhibiting multiple EF impairments often report greater academic and occupational difficulties [93,97]”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [93]
The Introduction says neurocognitive deficits are inherent to adult ADHD, and the Discussion addresses deficits on the stop-signal task. Neither section links multiple executive-function impairments to greater academic or occupational difficulties. Searches for academic performance, occupational difficulties, and work or school functioning found no passage addressing that relationship. (LLM, conf=0.73)
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References 69 · Cited by 59
- Authors
- Senkowski, D., Ziegler, T., Singh, M., Heinz, A., He, J., Silk, T., & Lorenz, R. C.
- Affiliations
- Humboldt-Universität zu Berlin (DE)
- Deakin University (AU)
- King's College London (GB)
- Max Planck Institute for Human Development (DE)
- Corresponding author
- Senkowski, Daniel
- Venue
- Neuropsychology Review
- Published
- 2023-06-10
- Volume
- 34
- Issue
- 2
- Pages
- 548-567
- ISSN
- 1040-7308 (ISSN-L)
- 1573-6660
- PMC
- PMC11166755
- OpenAlex
- W4380077564
- Cited by
- 59
- References
- 69
- Citations by year
- 2026: 22 · 2025: 21 · 2024: 15 · 2023: 1
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Neuropsychology Review (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PUBLISSO (German National Library of Medicine) (submittedVersion, cc-by)
- Universitätsbibliothek der FU Berlin Hochschulschriftenstelle u. Dokumentenserver (cc-by)
- Funders
- Charité - Universitätsmedizin Berlin
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- adult ADHD, inhibitory control, stop-signal task, response inhibition, sustained attention, omission errors, neuropsychological assessment, hyperactivity/impulsivity, inattention
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Humans, Inhibition, Psychological, Neuropsychological Tests, Reaction Time, Executive Function
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