European Child & Adolescent Psychiatry

, Volume 24, Issue 5, pp 575–590 | Cite as

Prevalence and diagnostic validity of motivational impairments and deficits in visuospatial short-term memory and working memory in ADHD subtypes

  • Sebastiaan Dovis
  • Saskia Van der Oord
  • Hilde M. Huizenga
  • Reinout W. Wiers
  • Pier J. M. Prins
Original Contribution


Deficits in working memory (WM) and reinforcement sensitivity are thought to give rise to symptoms in the combined (ADHD-C) and inattentive subtype (ADHD-I) of ADHD. Children with ADHD are especially impaired on visuospatial WM, which is composed of short-term memory (STM) and a central executive. Although deficits in visuospatial WM and reinforcement sensitivity appear characteristic of children with ADHD on a group-level, the prevalence and diagnostic validity of these impairments is still largely unknown. Moreover, studies investigating this did not control for the interaction between motivational impairments and cognitive performance in children with ADHD, and did not differentiate between ADHD subtypes. Visuospatial WM and STM tasks were administered in a standard (feedback-only) and a high-reinforcement (feedback + 10 euros) condition, to 86 children with ADHD-C, 27 children with ADHD-I (restrictive subtype), and 62 typically developing controls (aged 8–12). Reinforcement sensitivity was indexed as the difference in performance between the reinforcement conditions. WM and STM impairments were most prevalent in ADHD-C. In ADHD-I, only WM impairments, not STM impairments, were more prevalent than in controls. Motivational impairments were not common (22 % impaired) and equally prevalent in both subtypes. Memory and motivation were found to represent independent neuropsychological domains. Impairment on WM, STM, and/or motivation was associated with more inattention symptoms, medication-use, and lower IQ scores. Similar results were found for analyses of diagnostic validity. The majority of children with ADHD-C is impaired on visuospatial WM. In ADHD-I, STM impairments are not more common than in controls. Within both ADHD subtypes only a minority has an abnormal sensitivity to reinforcement.


ADHD subtypes Working memory Reinforcement Reward 



We are grateful to the participating mental-healthcare centers [Jeugdriagg Noord Holland Zuid, GGz Noord Holland Noord (Centrum voor Kinder- en Jeugdpsychiatrie), Regionaal Centrum voor Kinder en Jeugdpsychiatrie Gooi en Vechtstreek, Bosman GGz, Stichting De Praktijk, Stichting Kram, PuntP, Academisch Behandelcentrum UvA Minds, & Kinderpraktijk VIS] and the participating schools (OBS De Weidevogel, Amsterdam; OBS De Witte Olifant, Amsterdam; De Dr. E. Boekmanschool, Amsterdam; OBS Jules Verne, Alkmaar; PCBS Van der Brugghenschool, Huizen; Montessorischool De Boog, Nieuw-Vennep; and De Willemsparkschool, Amsterdam), to Jasper Wijnen for programming the task, to Tim van den Broek, Josje de Bont, Annette Brouwer, Tycho Dekkers, Lucie van den Eertwegh, Roza van der Heide, Lisanne Klink, Astrid Nauta, Inge Meulenberg, Muriël Musa, Pascale Riaskoff, Elise Tilma, Marije Voermans, Ida de Vries, and Pamina Warmbrunn for their help with data collection, and to all participating children and families.

Conflict of interest

SvdO has been a paid consultant for Janssen pharmaceuticals in the development and evaluation of a serious game “Healseeker” aimed at training cognitive functions. Other authors report no conflicts of interest.

Supplementary material

787_2014_612_MOESM1_ESM.docx (182 kb)
Supplementary material 1 (DOCX 182 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Sebastiaan Dovis
    • 1
  • Saskia Van der Oord
    • 1
    • 2
  • Hilde M. Huizenga
    • 1
  • Reinout W. Wiers
    • 1
  • Pier J. M. Prins
    • 1
  1. 1.Developmental PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Clinical PsychologyKU LeuvenLeuvenBelgium

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