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Cited by 504Attention Deficit Hyperactivity DisorderDevelopmental and Educational NeuropsychologyNeural and Behavioral Psychology Studies

Beyond the Dual Pathway Model: Evidence for the Dissociation of Timing, Inhibitory, and Delay-Related Impairments in Attention-Deficit/Hyperactivity Disorder

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Sonuga-Barke, Edmund, Bitsakou, Paraskevi, Thompson, Margaret·2010·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2009.12.018
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Abstract

Objective The dual pathway model explains neuro-psychological heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) in terms of dissociable cognitive and motivational deficits each affecting some but not other patients. We explore whether deficits in temporal processing might constitute a third dissociable neuropsychological component of ADHD. Method Nine tasks designed to tap three domains (inhibitory control, delay aversion and temporal processing) were administered to ADHD probands (n=71; ages 6 to 17 years), their siblings (n=71; 65 unaffected by ADHD) and a group of non-ADHD controls (n=50). IQ and working memory were measured. Results Temporal processing, inhibitory control and delay-related deficits represented independent neuropsychological components. ADHD children differed from controls on all factors. For ADHD patients, the co-occurrence of inhibitory, temporal processing and delay-related deficits was no greater than expected by chance with substantial groups of patients showing only one problem. Domain-specific patterns of familial co-segregation provided evidence for the validity of neuropsychological subgroupings. Conclusion The current results illustrate the neuropsychological heterogeneity in ADHD and initial support for a triple pathway model. The findings need to be replicated in larger samples.

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  • Across meta-analyses using traditional neuropsychological executive function tests for children with ADHD, 33%-50% of cases exhibited executive function deficits, including 30%-37% with impaired working memory and 21%-46% with impaired inhibitory control.

    “across meta-analyses using traditional neuropsychological executive function tests for children with ADHD, 33%-50% of cases exhibited executive function deficits (30%-37% impaired working memory, 21%-46% impaired inhibitory control).90,144–149”

    From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [146]

    The Neuropsychological studies section reports executive-function deficits in ADHD and cites a study finding that 30% of patients had deficits on at least three tasks in a large executive-function battery. It does not report the claimed meta-analytic ranges of 33%–50% overall, 30%–37% for working memory, or 21%–46% for inhibitory control. The paper’s own Results concern inhibition, timing, and delay-related deficits, not those ranges (page numbers unavailable in our copy). (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Neither this study nor previous studies have been able to improve the rate of impairment substantially by including a broader range of neuropsychological tasks.

    “Neither this study nor previous studies (Sonuga-Barke, Bitsakou, et al., 2010; Wåhlstedt et al., 2009) have been able to improve this rate substantially by including a broader range of neuropsychological tasks.”

    From Multiple deficits in ADHD: executive dysfunction, delay aversion, reaction time variability, and emotional deficits (2013) · cites this paper as Sonuga-Barke, Bitsakou, et al., 2010

    The Results (section labelled “Insert Table 4 about here”; page unavailable) report that 71% of ADHD cases had a deficit across the timing, inhibition, and delay domains, leaving a substantial minority without one despite the broad task battery. The introduction also describes limited impairment rates in earlier research. The paper does not establish that adding tasks failed to improve a comparable impairment rate substantially; the earlier 30% figure uses a different criterion—deficits on at least three tasks. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • According to the triple pathway model, deficits in temporal processing may represent a primary cause of the key symptoms of ADHD in addition to inhibitory control and delay-related processes.

    “According to the triple pathway model [46], deficits in temporal processing may represent a primary cause of the key symptoms of ADHD in addition to inhibitory control and delay-related processes.”

    From The faster internal clock in ADHD is related to lower processing speed: WISC-IV profile analyses and time estimation tasks facilitate the distinction between real ADHD and pseudo-ADHD (2017) · cites this paper as [46]

    The Abstract (page unavailable) reports initial support for a triple pathway model in which temporal processing, inhibitory control, and delay-related deficits are independent components of ADHD. The Discussion (page unavailable) likewise describes them as dissociable, but the paper does not establish that temporal processing deficits are a primary cause of ADHD’s key symptoms. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The affectivity hypothesis maintains that emotional lability in children with ADHD emerges through dysfunctional emotional processing itself, with emotional stimuli eliciting inordinately strong emotional responses.

    “An opposing hypothesis, which we term the “affectivity hypothesis,” maintains that emotional lability in children with ADHD emerges not from impaired executive functions, but rather through the more direct route of dysfunctional emotional processing itself.”

    From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [25]

    The Introduction and Results discuss inhibitory control, delay aversion, and timing deficits, but do not address the affectivity hypothesis or emotional lability. Searches for emotional processing, emotional stimuli, and strong emotional responses found no passage supporting the attributed claim. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 51

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Cited by

Sorted by citations

Authors
Sonuga-Barke, E., Bitsakou, P., & Thompson, M.
Affiliations
  • Ghent University (BE)
  • University of Southampton (GB)
Corresponding author
Sonuga-Barke, Edmund
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2010-04
Volume
49
Issue
4
Pages
345-355
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2009.12.018
OpenAlex
W1998876544
Cited by
504
References
18
Citations by year
2026: 8 · 2025: 21 · 2024: 23 · 2023: 31 · 2022: 32 · 2021: 43 · 2020: 41 · 2019: 28 · 2018: 41 · 2017: 33 · 2016: 38 · 2015: 35 · 2014: 46 · 2013: 30 · 2012: 33
FWCI
18.34
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
  • ePrints Soton (University of Southampton) (submittedVersion)
Funders
  • National Institutes of Health
  • Economic and Social Research Council
  • National Institute of Mental Health (R01MH062873, R01 MH62873-01A1)
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, dual-pathway model, temporal processing, inhibitory control, delay aversion, siblings, children and adolescents
MeSH terms
Attention Deficit Disorder with Hyperactivity, Child, Cognition, Humans, Inhibition, Psychological, Intelligence Tests, Memory, Short-Term, Models, Neurological, Models, Psychological, Motivation, Neuropsychological Tests, Neuropsychology, Time Perception, Siblings

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