Heterogeneity in development of aspects of working memory predicts longitudinal attention deficit hyperactivity disorder symptom change.
Open accessAbstract
The role of cognitive mechanisms in the clinical course of neurodevelopmental disorders is poorly understood. Attention Deficit Hyperactivity Disorder (ADHD) is emblematic in that numerous alterations in cognitive development are apparent, yet how they relate to changes in symptom expression with age is unclear. To resolve the role of cognitive mechanisms in ADHD, a developmental perspective that takes into account expected within-group heterogeneity is needed. METHOD: The current study uses an accelerated longitudinal design and latent trajectory growth mixture models in a sample of children ages 7-13 years carefully characterized as with (n = 437) and without (n = 297) ADHD to (a) identify heterogeneous developmental trajectories for response inhibition, visual spatial working memory maintenance, and delayed reward discounting and (b) to assess the relationships between these cognitive trajectories and ADHD symptom change. RESULTS: Best-fitting models indicated multiple trajectory classes in both the ADHD and typically developing samples, as well as distinct relationships between each cognitive process and ADHD symptom change. Developmental change in response inhibition and delayed reward discounting were unrelated to ADHD symptom change, while individual differences in the rate of visual spatial working memory maintenance improvement predicted symptom remission in ADHD. CONCLUSION: Characterizing heterogeneity in cognitive development will be crucial for clarifying mechanisms of symptom persistence and recovery. Results here suggest working memory maintenance may be uniquely related to ADHD symptom improvement. (PsycINFO Database Record
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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 [74]
Split into 2 atoms — 1 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredMost longitudinal studies have linked improvements in working memory, or executive functioning more generally, with remission of ADHD symptoms.
“For example, most longitudinal studies have linked improvements in working memory, or executive functioning more generally, with remission of ADHD symptoms (e.g., 74).”
From Working memory and inhibitory control deficits in children with ADHD: an experimental evaluation of competing model predictions (2024) · cites this paper as [74]
In the section labeled Abstract > Conclusion (page unavailable), the paper describes the longitudinal evidence as mixed and says several major prospective studies found no association between changes in verbal working memory or attention and ADHD symptom change. It reports a positive association for global executive functioning in one study and for visual working memory in a subgroup of its own sample, but does not support the claim that most longitudinal studies found such a link. (LLM, conf=0.83)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredWorking memory deficits in ADHD have been found to covary with ADHD behavioral symptoms in longitudinal and experimental studies.
“Working memory deficits are present in the majority of children with ADHD and have been shown to covary longitudinally and experimentally with ADHD behavioral symptoms (e.g., Karalunas et al., 2017; Kofler et al., 2018).”
From Working memory and short-term memory deficits in ADHD: A bifactor modeling approach (2020) · cites this paper as Karalunas et al., 2017
The Results (Within-group Heterogeneity in Neurocognitive Development; page not supplied) report visual working-memory impairment at age 7 in two ADHD groups totaling 85% of the sample. The Discussion reports that development of visual working memory was related to improvement in inattention symptoms over time. This supports longitudinal covariation, but the paper does not report an experimental test of that relationship. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCombined with longitudinal and experimental evidence, the evidence base implicates working memory as a core mechanism involved, at least in part, in the phenotypic expression of ADHD behavioral symptoms.
“Combined with longitudinal and experimental evidence (e.g., Karalunas et al., 2017; Rapport et al., 2009; Patros et al., 2017), the evidence base at this time implicates working memory as a core mechanism that is involved, at least in part, in the phenotypic expression of ADHD behavioral symptoms.”
From Working memory and short-term memory deficits in ADHD: A bifactor modeling approach (2020) · cites this paper as Karalunas et al., 2017
The Discussion (page unavailable) reports that development of visual-spatial working memory was associated with improvement in inattention symptoms in children, supporting a longitudinal link. It does not establish working memory as a core mechanism for ADHD behavioral symptoms generally: the association with hyperactivity-impulsivity was not statistically significant, and the Conclusion says working memory maintenance may be related to symptom improvement. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThis validity evidence includes experimental and longitudinal linkages between executive function performance tests and objective and subjective measures of inattention, hyperactivity, impulsivity, emotion recognition, reading skills, math performance, social skills, organizational skills, parent-child relationship quality, and activities of daily living.
“This concurrent and predictive validity evidence includes experimental and longitudinal linkages between EF performance tests, objective and subjective measures of inattention, hyperactivity, impulsivity, emotion recognition, reading skills, math performance, social skills, organizational skills, parent-child relationship quality, and activities of daily living (Karalunas et al., 2017; Wells et al”
From Assessment of executive functions in school-aged children: A narrative review (2022) · cites this paper as Karalunas et al., 2017
The Discussion (page unavailable) reports a longitudinal link between visual working-memory performance and parent- and teacher-reported inattention in children, supporting that part of the cited claim. It says changes in response inhibition and delayed reward valuation were unrelated to ADHD symptom changes, and it does not establish the claimed links to emotion recognition, academic or social skills, organization, parent-child relationships, or daily living. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Only 13% of children with ADHD have stable impairments in both inhibition and working memory, vs. 44% who have stable working memory but not inhibition deficits, and only 5% who have stable inhibition deficits but not working memory deficits.
“Karalunas et al. (74) also found that only 13% of children with ADHD have stable impairments in both inhibition and working memory (vs. 44% who have stable working memory but not inhibition deficits, and only 5% who have stable 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 [74]
The Results (Within-group Heterogeneity in Neurocognitive Development; Overlap in Trajectory Classes; page unavailable) report that 18.6% of the ADHD sample followed an impaired response-inhibition trajectory and that 74% of that group also followed a persistently impaired visual working-memory trajectory. Those figures support the general pattern of overlapping and distinct impairments, but the paper does not report the claimed 13%, 44%, and 5% breakdown; its reported figures do not reproduce the 44% figure. (LLM, conf=0.84)
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 [74]
The Results (Within-group Heterogeneity in Neurocognitive Development; Overlap in Trajectory Classes; page unavailable) report that 18.6% of children with ADHD were in the impaired response-inhibition class and 74% of that class also had persistently impaired visual working memory. This supports the claim that inhibition-only deficits were uncommon, but the paper does not establish the stated 5–11% range: the remaining 26% may include children with recovering working-memory impairment. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMost children with ADHD have working memory deficits.
“Working memory deficits are present in the majority of children with ADHD and have been shown to covary longitudinally and experimentally with ADHD behavioral symptoms (e.g., Karalunas et al., 2017; Kofler et al., 2018).”
From Working memory and short-term memory deficits in ADHD: A bifactor modeling approach (2020) · cites this paper as Karalunas et al., 2017
Recent 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 Karalunas et al., 2017
When ASD symptoms are controlled, evidence is mixed about whether youth with ADHD continue to show set shifting test deficits.
“When controlling for ASD symptoms, the evidence is mixed as to whether or not youth with ADHD continue to display deficits on set shifting tests.68,89”
From Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder (2024) · cites this paper as [89]
The paper’s description of its study measures names response inhibition, visual-spatial working memory, and delayed reward discounting, not set shifting (study focus and measures; page unavailable). The Method > Diagnostic Assessment section says children with a pervasive developmental disorder, including autism, were excluded. Searches for set shifting and analyses controlling for ASD symptoms found no passage addressing whether ADHD-related set-shifting deficits persist after that control. (LLM, conf=0.77)
Experimental — accuracy not yet measured
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Self-citationRelation Between Outcomes on a Continuous Performance Test and ADHD Symptoms Over Time
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Self-citationExecutive Functioning Heterogeneity in Pediatric ADHD
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Self-citationRevisiting the seven pillars of RDoC
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“Cognitive abilities develop rapidly over middle childhood and adolescence(Best and Miller 2010; Karalunas et al. 2017; Miller et al. 2013) and whether the ASD and ADHD groups show distinct trajectories of cognitive development is unable to be evaluated in this cross-sectional study.”
Self-citationExecutive functioning rating scales: Ecologically valid or construct invalid?
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“This concurrent and predictive validity evidence includes experimental and longitudinal linkages between executive function performance tests and objective and subjective measures of inattention, hyperactivity, impulsivity, emotion recognition, reading skills, math performance, social skills, organizational skills, pa…”
BackgroundExecutive 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
Working memory and short-term memory deficits in ADHD: A bifactor modeling approach
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“, 2012), as well as with studies using latent or composite estimates (d=1.41–1.67; 62%−85%; Karalunas et al., 2017; Kofler, Irwin et al., 2019).”
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Self-citationAdolescent Attention-Deficit/Hyperactivity Disorder: Understanding Teenage Symptom Trajectories
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Toward a revised nosology for attention-deficit/hyperactivity disorder heterogeneity
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Self-citationAn Examination of Relations Among Working Memory, ADHD Symptoms, and Emotion Regulation
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How do stimulant treatments for ADHD work? Evidence for mediation by improved cognition
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“…causal) evidence linking cognitive/behavioural models of executive function with important behavioural and functional outcomes in ADHD and ASD 25,33,89,155–158 , alternative executive function conceptualizations and measurement approaches (such as neurobiological and sociocultural insights) are…”
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“tion of children with ADHD exhibiting deficits in working memory abilities at a prevalence rate of 62% to 85% (Fosco et al., 2020; Karalunas et al., 2017; Kasper et al., 2012; Kofler et al., 2018; Sonuga-Barke et al., 2008).”
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A Review of Working Memory Training in the Management of Attention Deficit Hyperactivity Disorder
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The Efficacy of Cognitive Videogame Training for ADHD and What FDA Clearance Means for Clinicians
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Pediatric ADHD symptom burden relates to distinct neural activity across executive function domains
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- Authors
- Karalunas, S. L., Gustafsson, H. C., Dieckmann, N. F., Tipsord, J., Mitchell, S. H., & Nigg, J. T.
- Affiliations
- Oregon Health & Science University (US)
- ORCID
- Venue
- Journal of Abnormal Psychology
- Published
- 2017-08
- Volume
- 126
- Issue
- 6
- Pages
- 774-792
- ISSN
- 0021-843X (ISSN-L)
- 1939-1846
- PMC
- PMC5657320
- OpenAlex
- W2742297264
- Cited by
- 104
- References
- 97
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 7 · 2023: 18 · 2022: 20 · 2021: 14 · 2020: 17 · 2019: 6 · 2018: 9 · 2017: 1
- FWCI
- 7.41
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Abnormal Psychology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R37 MH059105, K23 MH108656)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- attention deficit hyperactivity disorder, working memory maintenance, visuospatial working memory, response inhibition, delay discounting, symptom remission, symptom change, within-group heterogeneity, children, developmental trajectories
- MeSH terms
- Adolescent, Analysis of Variance, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Impulsive Behavior, Inhibition, Psychological, Male, Memory, Short-Term, Neuropsychological Tests, Reward, Space Perception, Case-Control Studies
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