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The Ecological Validity of Delay Aversion and Response Inhibition as Measures of Impulsivity in AD/HD: A Supplement to the NIMH Multimodal Treatment Study of AD/HD
Abstract
Impulsivity is a primary symptom of the combined type of Attention Deficit/Hyperactivity Disorder (AD/HD). The Stop Signal Paradigm is premised upon a primary deficit in inhibitory control in AD/HD, whereas the Delay Aversion Hypothesis, by contrast, conceptualizes impulsivity in AD/HD, not as an inability to inhibit a response, but rather as a choice to avoid delay. This study compared the ecological validity of the Stop Signal Task (SST) and Choice-Delay Task (C-DT) measure of delay aversion, with respect to their relative utility in discriminating AD/HD children from normal control participants, and their correlations with classroom observations and with ratings of impulsivity and other core AD/HD symptoms on the Conners and SNAP-IV checklists. The tasks exhibited modest discriminant validity when used individually and excellent discriminant validity when used in combination. The C-DT correlated with teacher ratings of impulsivity, hyperactivity, and conduct problems, and with observations of gross motor activity, physical aggression, and an AD/HD composite score. The SST correlated with the observations only. These results suggest that delay aversion is associated with a broad range of AD/HD characteristics whereas inhibitory failure seems to tap a more discrete dimension of executive control.
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Inhibitory control deficits are detected in 21% to 46% of pediatric ADHD cases.
“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).”
From Executive Functioning Heterogeneity in Pediatric ADHD (2019) · cites this paper as Solanto et al., 2001
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 [145]
Impulsivity is likely a multi-dimensional construct that includes a family of related but separable processes and underlying neural systems.
“Given that different “objective” measures of impulsivity often fail to inter-correlate themselves [229], and there is also neural evidence of dissociation [230], it is likely that impulsivity, like CC and inhibition, is a multi-dimensional construct that includes a family of related but separable processes and underlying neural systems.”
From The role of prefrontal cortex in cognitive control and executive function (2022) · cites this paper as [229]
Visuospatial WM impairments are at least as prevalent in children with ADHD-C as other key neuropsychological dysfunctions.
“Further, our finding suggests that visuospatial WM impairments are at least as prevalent in children with ADHD-C as other 'key' neuropsychological dysfunctions (prevalence of inhibition, 45-51 %; reaction time variability, 44-48 %; delay aversion, 14-56 % [e.g., 17, 19, 22, 53]),”
From Prevalence and diagnostic validity of motivational impairments and deficits in visuospatial short-term memory and working memory in ADHD subtypes (2015) · cites this paper as [53]
In support of the dual path model, several experiments have shown that preferring delayed rewards and inhibiting control are dissociable.
“In support of this “dual path” model, several experiments (Sonuga-Barke et al., 1996; Solanto et al., 2001) have shown that preferring delayed rewards and inhibiting control are dissociable.”
From Assessment of executive functions in school-aged children: A narrative review (2022) · cites this paper as Solanto et al., 2001
The delay aversion deficit in ADHD is independent of deficits in inhibitory control.
“and that this deficit is independent of deficits in inhibitory control.”
From Multiple deficits in ADHD: executive dysfunction, delay aversion, reaction time variability, and emotional deficits (2013) · cites this paper as Solanto et al., 2001
ADHD is significantly related to delay aversion.
“Several studies (e.g., Dalen, Sonuga-Barke, Hall, & Remington, 2004; Solanto et al., 2001; Sonuga-Barke, Dalen, & Remington, 2003) have found that ADHD is significantly related to delay aversion”
From Multiple deficits in ADHD: executive dysfunction, delay aversion, reaction time variability, and emotional deficits (2013) · cites this paper as Solanto et al., 2001
DAv and inhibitory control deficits are uncorrelated but both are associated with ADHD; four subgroups can be identified: DAv only, inhibitory deficits only, both deficits, and neither deficit.
“For instance, the classic paper by Solanto et al., (2001) illustrates this most clearly -DAv and inhibitory control deficits were uncorrelated but yet both were associated with ADHD: Four subgroups of children could be identified -DAv and no inhibitory deficits; inhibitory deficits and no DAv; both deficits and neither deficits (see also Thorell, 2007).”
From Context-dependent Dynamic Processes in Attention Deficit/Hyperactivity Disorder: Differentiating Common and Unique Effects of State Regulation Deficits and Delay Aversion (2010) · cites this paper as Solanto et al., 2001
Some children with ADHD appear to have both delay aversion and executive dysfunction.
“some children appear to be affected both by DAv and executive dysfunction (Solanto et al., 2001).”
From Context-dependent Dynamic Processes in Attention Deficit/Hyperactivity Disorder: Differentiating Common and Unique Effects of State Regulation Deficits and Delay Aversion (2010) · cites this paper as Solanto et al., 2001
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“Several studies (e.g., Dalen, Sonuga-Barke, Hall, & Remington, 2004; Solanto et al., 2001; Sonuga-Barke, Dalen, & Remington, 2003) have found that ADHD is significantly related to delay aversion and that this deficit is independent of deficits in inhibitory control.”
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“…previous studies (e.g., Aman, Roberts, Jr., and Pennington 1998; Castellanos, Sonuga-Barke, Scheres, Di, Hyde, and Walters 2005; Nigg, Hinshaw, Carte, and Treuting 1998; Solanto et al. 2001; Sonuga-Barke, Taylor, Sembi, and Smith 1992; see review by Willcutt, Sonuga-Barke, Nigg, and Sergeant 2008).”
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“…via presynaptic effects, which may explain its dose-dependent effects in many previous studies as well as its therapeutic efficacy (in moderate doses) in a putatively hyperdopaminergic ADHD (Seeman and Madras, 1998, 2002; Solanto, 1998, 2002; Solanto et al., 2001; de Wit et al., 2002).”
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Metadata
- Authors
- Solanto, M. V., Abikoff, H., Sonuga-Barke, E., Schachar, R., Logan, G. D., Wigal, T., Hechtman, L., Hinshaw, S., & Turkel, E.
- Affiliations
- Long Island Jewish Medical Center (US)
- University of Southampton (GB)
- University of Toronto (CA)
- University of Illinois Urbana-Champaign (US)
- University of California, Irvine (US)
- McGill University (CA)
- University of California, Berkeley (US)
- Corresponding author
- Solanto, Mary V.
- ORCID
- Venue
- Journal of Abnormal Child Psychology
- Published
- 2001-06
- Volume
- 29
- Issue
- 3
- Pages
- 215-228
- ISSN
- 0091-0627 (ISSN-L)
- 1573-2835
- OpenAlex
- W1764010569
- Semantic Scholar
- 269252cb7b5ad6da891b2cad3e71ac8f7c24bfb8
- Cited by
- 639
- References
- 61
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 7 · 2023: 15 · 2022: 11 · 2021: 13 · 2020: 53 · 2019: 16 · 2018: 32 · 2017: 26 · 2016: 23 · 2015: 31 · 2014: 37 · 2013: 37 · 2012: 43
- FWCI
- 7.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Research on Child and Adolescent Psychopathology (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- 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, impulsivity, delay aversion, response inhibition, inhibitory control, stop-signal task, ecological validity, discriminant validity, executive function, hyperactivity, conduct problems, classroom observation, teacher ratings, children
- MeSH terms
- Analysis of Variance, Attention Deficit Disorder with Hyperactivity, California, Child, Child Behavior Disorders, Female, Humans, Impulsive Behavior, Inhibition, Psychological, Male, New York City, Psychological Tests, Quebec, Sensitivity and Specificity, Reproducibility of Results, Comorbidity, Case-Control Studies
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