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Impairments in executive function may be a hallmark of ADHD1

Impairments in executive function may be a hallmark of ADHD1

“The core symptoms of ADHD are developmental in nature.”2

-Frank Lopez, MD

Research indicates that children with attention-deficit/hyperactivity disorder (ADHD) develop 2 to 3 years more slowly than their neurotypical peers.3 Children with ADHD also tend to get poorer grades, score lower on standardized tests, experience peer rejection, and have poorer educational outcomes overall compared to those without ADHD.4 These differences in development may be due to the fact that the core symptoms of inattention and impulsivity result in lessened motivation and task persistence needed to facilitate learning behaviors.4

Children with ADHD often have issues with higher-order, goal-directed neurocognitive processes, including:

  • Cognitive inhibition (resisting distraction)5
  • Task switching5
  • Working memory6,7
  • Response inhibition and execution7

Additionally, children with ADHD frequently exhibit difficulties in language acquisition, including both receptive and expressive language.6

  • While simple word fluency may not be obviously impaired in ADHD, complex verbal fluency and discourse organization are more likely to be affected

  • The lessened capacity of children with ADHD to maintain internalized (self-directed) speech has also been linked to uninhibited behavior, making it more difficult for these children to follow rules and instructions

Children with ADHD often lag in development of social and emotional skills

Low frustration tolerance and explosive behavior are established symptoms of ADHD.8 However, emotional dysregulation is increasingly viewed as a core feature of the disorder rather than merely an associated symptom.1

  • It is now recognized that emotional dysregulation and deficient self-regulation are highly prevalent in ADHD and are major contributors to impairment1

Difficulties with emotional regulation may lead children with ADHD to struggle in important areas of social relatedness, including8,9:

  • Making new friends
  • Appropriately reading social cues
  • "Fitting in" with peers

Issues with social functioning, together with behavioral regulation, cause difficulties in the school setting and can limit academic achievement for children with ADHD.1,10

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References: 1. Brown TE. Developmental complexities of attentional disorders. In: Brown TE, Ed. ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults; Arlington, VA: American Psychiatric Publishing Inc; 2009:3-23. 2. Data on file. Supernus Pharmaceuticals, Inc. 3. Berger I, Slobodin O, Aboud M, Melamed J, Cassuto H. Maturational delay in ADHD: evidence from CPT. Front Hum Neurosci. 2013;7:691. 4. Colomer C, Berenguer C, Roselló B, Baixauli I, Miranda A. The impact of inattention, hyperactivity/impulsivity symptoms, and executive functions on learning behaviors of children with ADHD. Frontiers Psych. 2017;8(540):1-10. 5. Ter-Stepanian M, Grizenko N, Cornish K, et al. Attention and executive function in children diagnosed with attention deficit hyperactivity disorder and comorbid disorders. J Can Acad Child Adolesc Psychiatry. 2017;26(1):21-30. 6. Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull. 1997;121(1):65-94. 7. Adler LA, Clemow DB, Williams DW, Durell TM. Atomoxetine effects on executive function as measured by the BRIEF—in young adults with ADHD: a randomized, double-blind, placebo-controlled study. PLoS One. 2014;9(8):e104175. 8. van Stralen J. Emotional dysregulation in children with attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord. 2016;8(4):175-187. 9. Banaschewski T, Becker K, Dopfner M, Holtmann M, Rosler M, Romanos M. Attention-deficit/hyperactivity disorder. Dtsch Arztebl Int. 2017;114(9):149-159. 10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing Inc; 2013.