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Cited by 132Attention Deficit Hyperactivity DisorderAutism Spectrum Disorder ResearchMental Health Research Topics

Toward a revised nosology for attention-deficit/hyperactivity disorder heterogeneity

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Nigg, Joel T., Karalunas, Sarah L., Feczko, Eric, Fair, Damien A.·2020·Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
DOI 10.1016/j.bpsc.2020.02.005PMC PMC7423612
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Abstract

Attention-deficit/hyperactivity disorder (ADHD) is among the many syndromes in the psychiatric nosology for which etiological signal and clinical prediction are weak. Reducing phenotypic and mechanistic heterogeneity should be useful to arrive at stronger etiological and clinical prediction signals. We discuss key conceptual and methodological issues, highlighting the role of dimensional features aligned with Research Domain Criteria and cognitive, personality, and temperament theory as well as neurobiology. We describe several avenues of work in this area, utilizing different statistical, computational, and machine learning approaches to resolve heterogeneity in ADHD. We offer methodological and conceptual recommendations. Methodologically, we propose that an integrated approach utilizing theory and advanced computational logic to address targeted questions, with consideration of developmental context, can render the heterogeneity problem tractable for ADHD. Conceptually, we conclude that the field is on the cusp of justifying an emotionally dysregulated subprofile in ADHD that may be useful for clinical prediction and treatment testing. Cognitive profiles, while more nascent, may be useful for clinical prediction and treatment assignment in different ways depending on developmental stage. Targeting these psychological profiles for neurobiological and etiological study to capture different pathophysiological routes remains a near-term opportunity. Subtypes are likely to be multifactorial, cut across multiple dimensions, and depend on the research or clinical outcomes of interest for their ultimate selection. In this context parallel profiles based on cognition, emotion, and specific neural signatures appear to be on the horizon, each with somewhat different utilities. Efforts to integrate such cross-cutting profiles within a conceptual dysregulation framework are well underway.

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  • The hyperactive/impulsive ADHD presentation is more strongly linked to deficits in inhibitory control, response regulation, and delay aversion.

    “In contrast, the hyperactive/impulsive presentation is more strongly linked to deficits in inhibitory control, response regulation, and delay aversion, leading to impulsive behaviors and difficulties in behavioral self-monitoring [4,5].”

    From Executive Function Profiles in ADHD and Dyslexia: A Mixed-Method Neurocognitive Analysis (2026) · cites this paper as [4]

    The Cognitive heterogeneity in ADHD section discusses response inhibition and reward-related mechanisms as possible contributors to ADHD. It does not link inhibitory control, response regulation, or delay aversion more strongly to the hyperactive/impulsive presentation. Instead, it reports that cognitive control was related to inattention symptoms, while stimulus-driven processes were related to hyperactivity over time; the DSM-presentations section does not establish the claimed comparison. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Children with predominantly inattentive ADHD typically exhibit difficulties in sustained attention, working memory, and processing speed.

    “Children with the predominantly inattentive presentation typically exhibit difficulties in sustained attention, working memory, and processing speed, often manifesting as disorganization, forgetfulness, and reduced task persistence [3,4].”

    From Executive Function Profiles in ADHD and Dyslexia: A Mixed-Method Neurocognitive Analysis (2026) · cites this paper as [4]

    The “Cognitive heterogeneity in ADHD” section (page unavailable) links cognitive control to inattention symptoms and discusses working-memory differences in ADHD. It does not establish that children with the predominantly inattentive presentation typically have all three stated difficulties; in particular, the cited passages do not link processing speed to that presentation. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Executive function deficits are neither universal nor specific to any single ADHD presentation, and substantial intra-group variability exists.

    “However, growing evidence suggests that executive function deficits are neither universal nor specific to any single ADHD presentation, and substantial intra-group variability exists [4,6].”

    From Executive Function Profiles in ADHD and Dyslexia: A Mixed-Method Neurocognitive Analysis (2026) · cites this paper as [4]

    The “Cognitive heterogeneity in ADHD” section says only some children have executive-function problems and describes distinct cognitive subgroups, supporting nonuniversality and within-ADHD variability. It also reports similar profiles in ADHD and typically developing populations. However, the cited passages do not establish whether executive-function deficits are specific to any one DSM ADHD presentation. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

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Authors
Nigg, J. T., Karalunas, S. L., Feczko, E., & Fair, D. A.
Affiliations
Oregon Health & Science University (US)
Corresponding author
Nigg, Joel T.
ORCID
Venue
Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
Publisher
Elsevier BV
Published
2020-08
Volume
5
Issue
8
Pages
726-737
ISSN
2451-9022 (ISSN-L)
DOI
10.1016/j.bpsc.2020.02.005
PMC
PMC7423612
OpenAlex
W3006683661
Cited by
132
References
147
Citations by year
2026: 15 · 2025: 21 · 2024: 25 · 2023: 25 · 2022: 25 · 2021: 13 · 2020: 8
FWCI
2.94
Type
journal article
Language
en
Open access
Licence
Locations
  • Biological Psychiatry Cognitive Neuroscience and Neuroimaging (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords
attention deficit hyperactivity disorder, disease classification, phenotypic heterogeneity, dimensional models, Research Domain Criteria, emotional dysregulation, cognitive profile, personality and temperament, neurobiology of ADHD, clinical prediction, treatment allocation, machine learning, developmental context
MeSH terms
Attention Deficit Disorder with Hyperactivity, Cognition, Humans, Temperament

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