Cited by 233Attention Deficit Hyperactivity DisorderDevelopmental and Educational NeuropsychologyChild and Adolescent Psychosocial and Emotional Development

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Do Executive Deficits and Delay Aversion Make Independent Contributions to Preschool Attention-Deficit/Hyperactivity Disorder Symptoms?

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Sonuga-Barke, Edmund J.S., Dalen, Lindy, Remington, Bob·2003·Journal of the American Academy of Child & Adolescent Psychiatry

DOI 10.1097/01.chi.0000087564.34977.21

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Abstract

Objective To test whether deficits in executive function and delay aversion make independent contributions to levels of attention-deficit/hyperactivity disorder (ADHD) symptoms exhibited by preschool children.Method One hundred fifty-six children between 3 and 5.5 years old (78 girls and 78 boys) selected from the community completed an age-appropriate battery of tests measuring working memory, set shifting, planning, delay of gratification, and preference for delayed rewards. Parents completed a clinical interview about their children's ADHD symptoms.Results Analysis of test performance revealed two factors: executive dysfunction and delay aversion. Multivariate analysis demonstrated that when other factors (i.e., age, IQ, and conduct problems) were controlled, executive dysfunction and delay aversion each made significant independent contributions to predictions of ADHD symptoms.Conclusions Preschool ADHD symptoms are psychologically heterogeneous. Executive dysfunction and delay aversion may represent two distinct and early appearing neurodevelopmental bases for ADHD symptoms.

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Method
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Background
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Background
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Background
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Method
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BackgroundSelf-citation
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BackgroundSelf-citation
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Background
Response Inhibition in Preschoolers at Familial Risk for Attention Deficit Hyperactivity Disorder: A Behavioral and Electrophysiological Stop-Signal Study
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Self-citation
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“New computerized measures like the Teddy Task (Sonuga-Barke et al., 2003) or the Flower Task (Solanto et al., 2001) establish the same choice in more trials.”
MethodInfluential
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ResultInfluential
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Background
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Result
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Reward-Related Dysfunctions in Children Developing Attention Deficit Hyperactivity Disorder—Roles of Oppositional and Callous-Unemotional Symptoms
Schloß, S., Derz, F., Schurek, P., Cosan, A. S., Becker, K., & Pauli‐Pott, U. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.738368 · Cited by 5
“The preschool version of the PACS interview has demonstrated good psychometric properties, and has proven to be suitable for the assessment of ADHD symptoms as a dimensional variable (33).”
Method
Attention-deficit/hyperactivity disorder (ADHD) in cultural context II: a comparison of the links between ADHD symptoms and waiting-related responses in Hong Kong and UK
Chan, W. W.-Y., Shum, K. K., Downs, J. M., Liu, N. T., & Sonuga-Barke, E. J. S. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02506-7 · Cited by 7
“Despite cultural variations in expressing and reporting ADHD-related behaviours, previous indirect comparisons suggest similar correlations between ADHD symptoms and waiting responses in HK and UK [ 53, 69 ].”
InfluentialSelf-citation
Are ADHD trajectories shaped by the social environment? A longitudinal study of maternal influences on the preschool origins of delay aversion
Chan, W. W. Y., Shum, K., Downs, J., & Sonuga-Barke, E. (2024) · Journal of Child Psychology and Psychiatry and Allied Disciplines · doi:10.1111/jcpp.14103 · Cited by 5
Self-citation
The “EF” in deficiency: Examining the linkages between executive function and the utilization deficiency observed in preschoolers
Stone, M. M., Blumberg, F. C., Blair, C., & Cancelli, A. A. (2016) · Journal of Experimental Child Psychology · doi:10.1016/j.jecp.2016.07.003 · Cited by 5
Disruptive Behavior Disorders
Baumgaertel, A., Blaskey, L. G., & Antia, S. X. (2008) · Humana Press eBooks · doi:10.1007/978-1-59745-252-6_18 · Cited by 5
Parent-Child Interaction Therapy as a Treatment for ADHD in Early Childhood: A Multiple Baseline Single-Case Design
DeLoatche, K. J. (2015) · Digital Commons - University of South Florida (University of South Florida) · Cited by 5
Association between parent reports of attention deficit hyperactivity disorder behaviours and child impulsivity in children with severe intellectual disability
Bigham, K. D., Daley, D., Hastings, R. P., & Jones, R. S. P. (2012) · Journal of Intellectual Disability Research · doi:10.1111/j.1365-2788.2011.01522.x · Cited by 7
Parent Training for ADHD: No Generalization of Effects From Clinical to Neuropsychological Outcomes in a Randomized Controlled Trial
Lambek, R., Sonuga-Barke, E. J. S., Lange, A., Carroll, D. J., Daley, D., & Thomsen, P. H. (2022) · Journal of Attention Disorders · doi:10.1177/10870547221130108 · Cited by 4
“…disorder (ADHD) is associated with a heterogeneous pattern of neuropsychological deficits (Posner et al., 2020) present from early in life (Breaux et al., 2016; Hwang-Gu et al., 2019; Patros et al., 2016; Pauli-Pott & Becker, 2011; Skogan et al., 2015; Sonuga-Barke et al., 2003).”
BackgroundMethodSelf-citation
Cognitive Profiles in Preschool Children at Risk for Co-Occurring Dyslexia and ADHD
Kellens, S., Baeyens, D., & Ghesquière, P. (2024) · Education Sciences · doi:10.3390/educsci14040435 · Cited by 6
“There was a moderate correlation be-tween the two”
Background
How neuropsychology can inform our understanding of preschool ADHD: Clinical and research implications
Aretouli, E. (2018) · Applied Neuropsychology Child · doi:10.1080/21622965.2017.1421463 · Cited by 6
“In addition to EC, delay aversion was 176 E. ARETOULI found to independently predict ADHD symptoms, above and beyond age, IQ, and conduct problems (Sonuga-Barke et al., 2003).”
Background
Feature Binding and Working Memory in Children with ADHD: Evidence of Episodic Buffer Impairment
Alderson, R. M., Tarle, S. J., Roberts, D. K., Betancourt, J. L., & Bullard, C. C. (2021) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-021-00868-z · Cited by 7
“Buffer Impairment Deficits of executive functions have assumed an enduring and central role in contemporary models of attention-deficit/ hyperactivity disorder (ADHD; Barkley, 1997; Halperin & Schulz, 2006; Rapport et al., 2001; Sonuga-Barke, 2003).”
Background
Attention-Deficit/Hyperactivity Disorder and Sports
MacLean, L., & Prabhakar, D. (2021) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2021.04.014 · Cited by 4
“The impairments seen at this age are similar to those seen in older school age children.(3) ADHD in these age groups is characterized by inattentive, hyperactive, and impulsive behaviors.”
Method
Expressed Emotion, Mutter-Kind-Beziehung und ADHS-Symptome im Vorschulalter
Schloß, S., Schramm, M., Christiansen, H., Scholz, K., Schuh, L. C., Döpfner, M., Becker, K., & Pauli‐Pott, U. (2015) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000384 · Cited by 4
An experimental task to measure preschool children’s frustration induced by having to wait unexpectedly: The role of sensitivity to delay and culture
Chan, W. W.-Y., Shum, K. K., Downs, J. M., & Sonuga-Barke, E. J. S. (2023) · Journal of Experimental Child Psychology · doi:10.1016/j.jecp.2023.105763 · Cited by 8
Self-citation
Aggressive Kinder: Welche Bedeutung besitzt der Belohnungsaufschub?
Gledhill, D., & Petermann, F. (2013) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000109 · Cited by 3
Functional and Structural MRI Studies on Impulsiveness: Attention-Deficit/Hyperactive Disorder and Borderline Personality Disorders
Archer, T., & Bright, P. (2012) · InTech eBooks · doi:10.5772/22915 · Cited by 3
“Nevertheless, a motivation-based account of altered reward processing, consisting of fronto-ventral striatal reward circuits and those meso-limbic branches that terminate in the ventral striatum and nucleus accumbens, implicates the avoidance of delay due to disturbances in the reward centres (Dalen et al., 2004; Sonu…”
Background
Hand Dexterity Evaluation Grounded on Cursor Trajectory Investigation in Children with ADHD Using a Mouse and a Joystick
Pino, A., Papatheodorou, N., Κουρουπέτρογλου, Γ., Giannopoulos, P.-A., Makris, G., & Papageorgiou, C. (2025) · Technologies · doi:10.3390/technologies13030099 · Cited by 4
Attention Deficit Hyperactivity Disorder: Second Wave Conceptualization and Intervention
Canu, W. H., & Hilton, D. C. (2022) · Springer eBooks · doi:10.1007/978-3-031-11677-3_27 · Cited by 3
Parenting in the early years and self-harm in adolescence: The role of control and reward systems in childhood
Dawe‐Lane, E., & Flouri, E. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.07.061 · Cited by 4
Functional Asthma Severity and Impulsive Behaviour in 6 and 7 Year-old Children
Schuckard, E. (2007) · UC Research Repository (University of Canterbury) · doi:10.26021/10065 · Cited by 2
A Randomized-Controlled Trial of Mindfulness and Executive Function Trainings to Promote Self-Regulation in Internationally Adopted Children
Lawler, J. M. (2015) · University of Minnesota Digital Conservancy (University of Minnesota) · Cited by 2
Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörungen in der Lebensspanne
Klein, C. (2012) · Nervenheilkunde · doi:10.1055/s-0038-1628240 · Cited by 1
“Die Vorschuldiagnostik der ADHS scheint durchaus sinnvoll, da Vorschulkinder eine ähnliche Symptomatik (10) sowie ähnliche Beeinträchtigungen und Komorbiditäten aufweisen wie Schulkinder mit ADHS (11).”
Background
Do Portuguese Preschoolers With High Hyperactive Behaviors Make More Progress Than Those With Low Hyperactivity After Parental Intervention?
Azevedo, A. F., Seabra‐Santos, M. J., Gaspar, M. F., & Homem, T. C. (2015) · Journal of Early Intervention · doi:10.1177/1053815115598006 · Cited by 1
“, academic underachievement, antisocial behavior, social exclusion, delinquency, and substance use) (e.g., Lahey et al 2004; DuPaul et al., 2001; Sonuga-Barke et al., 2003).”
Diferencias de la Función Ejecutiva en el Trastorno por Déficit de Atención con Hiperactividad y en sintomatologías asociadas
Jiménez, A., & Jiménez, E. A. A. (2012) · TDX (Tesis Doctorals en Xarxa) · Cited by 1
PROTOCOL: Parent training interventions for attention deficit hyperactivity disorder
Zwi, M., Jones, H. G., Thorgaard, C., York, A., & Dennis, J. A. (2009) · Campbell Systematic Reviews · doi:10.1002/cl2.58 · Cited by 3
Parenting Children With Attention Deficit Hyperactivity Disorder
Deka, D. B. (2020) · Advances in medical diagnosis, treatment, and care (AMDTC) book series · doi:10.4018/978-1-7998-5495-1.ch010 · Cited by 1
Measures of executive functions predicting Attention-Deficit/Hyperactivity Disorder core symptoms
Boshomane, T. T., Pillay, B. J., & Meyer, A. (2021) · African Journal of Psychological Assessment · doi:10.4102/ajopa.v3i0.48 · Cited by 1
“Researchers in the area have repeatedly emphasised the need to take the heterogeneity of EFs into account when studying the symptomatology of ADHD (Sonuga-Barke et al., 2002, 2003; Thorell & Wåhlstedt, 2006).”
Hair brain-derived neurotrophic factor (BDNF) as predictor of developing psychopathological symptoms in childhood
Pauli‐Pott, U., Cosan, A. S., Schloß, S., Skoluda, N., Nater, U. M., Tumala, S., Kruse, J., & Peters, E. M. J. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.10.007 · Cited by 2
Zoom sur les déficits neuropsychologiques du TDA/H : d’une perspective globale à une perspective spécifique
Pire, M., & Broeck, N. V. (2012) · L’Année psychologique · doi:10.4074/s0003503312001066 · Cited by 3
Problem Behaviors of Children from Multicultural and Mono-cultural Families in Korea: Differences in Behavior Evaluations between Parents and Teachers
(2021) · FWU Journal of Social Sciences · doi:10.51709/19951272/fall-2021/4 · Cited by 1
Eine Längsschnittstudie zur Vorhersage von ADHS-Symptomen und Schulleistungen in der 1. Klasse durch exekutive Funktionen im Vorschulalter
Koerner, J. K. A., Daseking, M., & Gawrilow, C. (2022) · Kindheit und Entwicklung · doi:10.1026/0942-5403/a000383 · Cited by 1
Sensitivity to reward frequency and reward delay in children with Attention-Deficit/Hyperactivity Disorder
McEachen, B. T. G. (2011) · Otago University Research Archive (University of Otago) · Cited by 1
Childhood Self-Regulation, Academic Achievement, and Occupational Attainment
Andersson, H. (2012) · PsycEXTRA Dataset · doi:10.1037/e529672013-001 · Cited by 1

Authors: Sonuga-Barke, E. J. S., Dalen, L., & Remington, B.
Affiliations: Economic and Social Research Council (GB)
Corresponding author: Sonuga-Barke, Edmund J.S.
ORCID: Sonuga-Barke, Edmund J.S.
Remington, Bob
Venue: Journal of the American Academy of Child & Adolescent Psychiatry
Publisher: Elsevier BV
Published: 2003-11
Volume: 42
Issue: 11
Pages: 1335-1342
ISSN: 0890-8567 (ISSN-L)
DOI: 10.1097/01.chi.0000087564.34977.21
OpenAlex: W2007093632
Cited by: 233
References: 48
Citations by year: 2026: 2 · 2025: 2 · 2024: 6 · 2023: 3 · 2022: 5 · 2021: 8 · 2020: 12 · 2019: 2 · 2018: 12 · 2017: 10 · 2016: 14 · 2015: 16 · 2014: 12 · 2013: 12 · 2012: 14
FWCI: 6.53
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
PubMed (publishedVersion)
ePrints Soton (University of Southampton) (acceptedVersion)
Funders: Economic and Social Research Council
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, preschool children, executive dysfunction, delay aversion, delay of gratification, working memory, set-shifting, planning
MeSH terms: Attention Deficit Disorder with Hyperactivity, Child, Preschool, Cognition Disorders, Female, Humans, Male, Neuropsychological Tests, Severity of Illness Index, Diagnostic and Statistical Manual of Mental Disorders

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Do Executive Deficits and Delay Aversion Make Independent Contributions to Preschool Attention-Deficit/Hyperactivity Disorder Symptoms?

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