Journal of Abnormal Child Psychology

, Volume 36, Issue 5, pp 745–758 | Cite as

Response Style Differences in the Inattentive and Combined Subtypes of Attention-Deficit/Hyperactivity Disorder

  • Karen J. Derefinko
  • Zachary W. Adams
  • Richard Milich
  • Mark T. Fillmore
  • Elizabeth P. Lorch
  • Donald R. Lynam


This study examined potential differences between the inattentive and combined ADHD subtypes using laboratory tasks assessing behavioral inhibitory processes. Seventy-five children completed two tasks of behavioral inhibition believed to isolate different processes: the cued reaction time task (CRT), a basic inhibition task, and the go/no-go task (GNG), a complex inhibition task that incorporates motivational contingencies. Three groups of participants were identified, including ADHD/Inattentive (n = 17), ADHD/Combined (n = 37), and comparison (n = 21). Results indicated that rather than showing behavioral inhibition deficits, the ADHD/I children appeared overly inhibited, as evidenced by slower reaction times across the two tasks and significantly higher errors of omission in the GNG task. Additionally, the ADHD/I children did not demonstrate cue dependency effects on the CRT task, suggesting that they were failing to incorporate relevant information before making a response. The sluggish and inhibited performance of the ADHD/I group challenges the idea that it is a subtype of ADHD.


ADHD Subtypes Disinhibition Sluggish cognitive tempo 



This research was supported by the National Institute on Drug Abuse grants DA021027 and DA005312.


  1. Abroms, B. D., Fillmore, M. T., & Marczinski, C. A. (2003). Alcohol-induced impairment of behavioral control: Effects on the alteration and suppression of prepotent responses. Journal of Studies on Alcohol, 64, 687–695.PubMedGoogle Scholar
  2. Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 profile. Burlington: University of Vermont Department of Psychiatry.Google Scholar
  3. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  4. Baeyens, D., Roeyers, H., & Vande Walle, J. (2006). Subtypes of attention-deficit/hyperactivity disorder (ADHD): Distinct or related disorders across measurement levels? Child Psychiatry and Human Development, 36, 403–417.PubMedCrossRefGoogle Scholar
  5. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.PubMedCrossRefGoogle Scholar
  6. Barkley, R. A. (2001). The inattentive type of ADHD as a distinct disorder: What remains to be done. Clinical Psychology: Science and Practice, 8, 489–493.CrossRefGoogle Scholar
  7. Barkley, R. A. (2006). Attention-deficit hyperactivity disorder, 3rd ed.: A handbook for diagnosis and treatment. New York, NY: Guilford Press.Google Scholar
  8. Barr, C. L., Wigg, K. G., Bloom, S., Schachar, R., Tannock, R., Roberts, W., et al. (2000). Further evidence from haplotype analysis for linkage of the dopamine D4 receptor gene and ADHD. American Journal of Medical Genetics, 96, 262–267.PubMedCrossRefGoogle Scholar
  9. Bauermeister, J. J., Barkley, R. A., & Martinez, J. V. (2005). Time estimation and performance on reproduction tasks in subtypes of children with attention deficit hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 34, 151–162.PubMedCrossRefGoogle Scholar
  10. Carlson, C. L., & Mann, M. (2000). Attention-deficit/hyperactivity disorder, predominately inattentive subtype. Child and Adolescent Psychiatric Clinics of North America, 9, 499–510.PubMedGoogle Scholar
  11. Carlson, C. L., & Mann, M. (2002). Sluggish cognitive tempo predicts a different pattern of impairment in the attention deficit hyperactivity disorder, primarily inattentive type. Journal of Clinical Child and Adolescent Psychology, 31, 123–129.PubMedCrossRefGoogle Scholar
  12. Carr, L. A., Nigg, J. T., & Henderson, J. M. (2006). Attentional versus motor inhibition in adults with attention deficit/hyperactivity disorder. Neuropsychology, 4, 430–441.CrossRefGoogle Scholar
  13. Castellanos, F. X., Sonuga-Barke, E. J. S., Milham, M. P., & Tannock, R. (2006). Characterizing cognition in ADHD: Beyond executive dysfunction. Trends in Cognitive Sciences, 10, 117–123.PubMedCrossRefGoogle Scholar
  14. Castellanos, F. X., & Tannock, R. (2002). Neuroscience of attention-deficit/hyperactivity disorder: The search for endophenotypes. Nature Reviews: Neuroscience, 3, 617–628.PubMedGoogle Scholar
  15. Conners, C. K. (1997). Conners’ rating scales—revised: Technical manual. North Tonawanda, NY: Multi-Health Systems.Google Scholar
  16. Daly, G., Hawi, Z., Fitzgerald, M., & Gill, M. (1999). Mapping susceptibility loci in attention deficit hyperactivity disorder: Preferential transmission of parental alleles at DAT1, DBH and DRD5 to affected children. Molecular Psychiatry, 4, 192–196.PubMedCrossRefGoogle Scholar
  17. Diamond, A. (2005). Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention deficit/hyperactivity (with hyperactivity). Development and Psychopathology, 17, 807–825.PubMedCrossRefGoogle Scholar
  18. Durston, S., Davidson, M. C., Mulder, M. J., Spicer, J. A., Galvan, A., Tottenham, N., et al. (2007). Neural and behavioral correlates of expectancy violations in attention-deficit hyperactivity disorder. Journal of Child Psychology and Psychiatry, 48, 881–889.PubMedCrossRefGoogle Scholar
  19. Epstein, J. N., Johnson, D. E., Varia, I. M., & Conners, C. K. (2001). Neuropsychological assessment of response inhibition in adults with ADHD. Journal of Clinical and Experimental Neuropsychology, 23, 362–371.PubMedGoogle Scholar
  20. Faraone, S. V., Biederman, J., Weber, W., & Russell, R. L. (1998). Psychiatric, neuropsychological, and psychosocial features of DSM-IV subtypes of attention-deficit/hyperactivity disorder: Results from a clinically referred sample. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 185–193.PubMedCrossRefGoogle Scholar
  21. Fillmore, M. T., Marczinski, C. A., & Bowman, A. M. (2005). Acute tolerance to alcohol effects on inhibitory and activational mechanisms of behavioral control. Journal of Studies on Alcohol, 66, 663–672.PubMedGoogle Scholar
  22. Flory, K., Milich, R., Lorch, E. P., Hayden, A. N., Strange, C., & Welsh, R. (2006). Online story comprehension among children with ADHD: Which core deficits are involved? Journal of Abnormal Child Psychology, 34, 853–865.PubMedCrossRefGoogle Scholar
  23. Gray, J. A. (1991). The neuropsychology of temperament. In J. Strelau, & A. Angleitner (Eds.) Explorations in temperament: International perspectives on theory and measurement (pp. 105–128). Plenum: New York, NY.Google Scholar
  24. Hartman, C. A., Willcutt, E. G., Rhee, S. H., & Pennington, B. F. (2004). The relation between sluggish cognitive tempo and DSM-IV ADHD. Journal of Abnormal Child Psychology, 32, 491–503.PubMedCrossRefGoogle Scholar
  25. Hartung, C. M., Milich, R., Lynam, D. R., & Martin, C. A. (2002). Understanding the relations among gender, disinhibition, and disruptive behavior in adolescents. Journal of Abnormal Psychology, 111, 659–664.PubMedCrossRefGoogle Scholar
  26. Hinshaw, S. P. (2001). Is the inattentive type of ADHD a separate disorder? Clinical Psychology: Science and Practice, 8, 498–501.CrossRefGoogle Scholar
  27. Hinshaw, S. P. (2002). Preadolescent girls with attention-deficit/hyperactivity disorder: I. Background characteristics, comorbidity, cognitive and social functioning, and parenting practices. Journal of Consulting and Clinical Psychology, 70, 1086–1098.PubMedCrossRefGoogle Scholar
  28. Huang-Pollock, C. L., Mikami, A. Y., Pfiffner, L., & McBurnett, K. (2007). ADHD subtype differences in motivational responsivity but not inhibitory control: Evidence from a reward-based variation of the stop signal paradigm. Journal of Clinical Child and Adolescent Psychology, 36, 127–136.PubMedCrossRefGoogle Scholar
  29. Iaboni, F., Douglas, V. I., & Baker, A. G. (1995). Effects of reward and response costs on inhibition in ADHD children. Journal of Abnormal Psychology, 104, 232–240.PubMedCrossRefGoogle Scholar
  30. Iaboni, F., Douglas, V. I., & Ditto, B. (1997). Psychophysiological response of ADHD children to reward and extinction. Psychophysiology, 34, 116–123.PubMedCrossRefGoogle Scholar
  31. Lahey, B. B. (2001). Should the combined and predominantly inattentive types of ADHD be considered distinct and unrelated disorders? Not now, at least. Clinical Psychology: Science and Practice, 8, 494–497.CrossRefGoogle Scholar
  32. Lahey, B. B., Pelham, W. E., Loney, J., Lee, S. S., & Willcutt, E. (2005). Instability of the DSM-IV Subtypes of ADHD From Preschool Through Elementary School. Archives of General Psychiatry, 62, 896–902.PubMedCrossRefGoogle Scholar
  33. Lijffijt, M., Kenemans, J. L., Verbaten, M. N., & van Engeland, H. (2005). A meta-analytic review of stopping performance in attention-deficit/hyperactivity disorder: Deficient inhibitory motor control? Journal of Abnormal Psychology, 114, 216–222.PubMedCrossRefGoogle Scholar
  34. Logan, G. D. (1994). On the ability to inhibit thought and action: A users’ guide to the stop signal paradigm. In D. Dagenbach, & T. H. Carr (Eds.) Inhibitory processes in attention, memory, and language (pp. 189–239). Toronto: Academic.Google Scholar
  35. Logan, G. D., & Cowan, W. B. (1984). On the ability to inhibit thought and action: A theory of an act of control. Psychological Review, 91, 295–327.CrossRefGoogle Scholar
  36. Logan, G. D., & Irwin, D. E. (2000). Don’t look! Don’t touch! Inhibitory control of eye and hand movements. Psychonomic Bulletin & Review, 7, 107–112.Google Scholar
  37. Lorch, E. P., Sanchez, R. P., van den Broek, P., Milich, R., Murphy, E. L., Lorch, R. F., et al. (1999). The relation of story structure properties to recall of television stories in young children with attention-deficit hyperactivity disorder and nonreferred peers. Journal of Abnormal Child Psychology, 27, 293–309.PubMedCrossRefGoogle Scholar
  38. Luman, M., Oosterlaan, J. A., & Sergeant, J. (2005). The impact of reinforcement contingencies on AD/HD: A review and theoretical appraisal. Clinical Psychology Review, 25, 183–213.PubMedCrossRefGoogle Scholar
  39. MacCoon, D. G., Wallace, J. F., & Newman, J. P. (2004). Self-regulation: Context-appropriate balanced attention. In K. D. Vohs, & R. F. Baumeister (Eds.) Handbook of self-regulation: Research, theory, and applications (pp. 422–444). New York, NY: Guilford Press.Google Scholar
  40. Maedgen, J., & Carlson, C. L. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29, 30–42.PubMedCrossRefGoogle Scholar
  41. Marczinski, C. A., & Fillmore, M. T. (2003). Preresponse cues reduce the impairing effects of alcohol on the execution and suppression of responses. Experimental and Clinical Psychopharmacology, 11, 110–117.PubMedCrossRefGoogle Scholar
  42. Marshall, R. M., Hynd, G. W., Handwerk, M. J., & Hall, J. (1997). Academic underachievement in ADHD subtypes. Journal of Learning Disabilities, 30, 635–642.PubMedGoogle Scholar
  43. McBurnett, K., Pfiffner, L. J., Willcutt, E., Tamm, L., Lerner, M., Ottolini, Y. L., et al. (1999). Experimental cross-validation of DSM-IV types of attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 17–24.PubMedCrossRefGoogle Scholar
  44. Milich, R., Balentine, A. C., & Lynam, D. R. (2001). ADHD combined type and ADHD predominantly inattentive type are distinct and unrelated disorders. Clinical Psychology: Science and Practice, 8, 463–488.CrossRefGoogle Scholar
  45. Milich, R., Hartung, C. M., Martin, C. A., & Haigler, E. D. (1994). Behavioral disinhibition and underlying processes in adolescents with disruptive behavior disorders. In D. K. Routh (Ed.) Disruptive behavior disorders in childhood (pp. 109–138). New York: Plenum.Google Scholar
  46. Newman, J. P., & Kosson, D. (1996). Passive avoidance learning in psychopathic and nonpsychopathic children. Journal of Abnormal Psychology, 95, 2257–2263.Google Scholar
  47. Newman, J. P., & Wallace, J. F. (1993). Diverse pathways to deficient self-regulation: Implications for disinhibitory psychopathology in children. Clinical Psychology Review, 13, 699–720.CrossRefGoogle Scholar
  48. Nichols, S. L., & Waschbusch, D. A. (2004). A review of the validity of laboratory cognitive tasks used to assess symptoms of ADHD. Child Psychiatry and Human Development, 34, 297–315.PubMedCrossRefGoogle Scholar
  49. Nigg, J. T. (2000). On inhibition/disinhibition in developmental psychopathology: Views from cognitive and personality psychology and a working inhibition taxonomy. Psychological Bulletin, 126, 200–246.CrossRefGoogle Scholar
  50. Nigg, J. T. (2001). Is ADHD an inhibitory disorder? Psychological Bulletin, 127, 571–598.PubMedCrossRefGoogle Scholar
  51. Nigg, J. T. (2006). What causes ADHD?: Understanding what goes wrong and why. New York, NY: Guilford Press.Google Scholar
  52. Nigg, J. T., Blaskey, L. G., Huang-Pollock, C. L., & Rappley, M. D. (2002). Neuropsychological executive functions and DSM-IV ADHD subtypes. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 59–66.CrossRefGoogle Scholar
  53. O'Driscoll, D. A., Depatie, L., Holahan, A. V., Savion-Lemieux, T., Barr, R. G., Jolicoeur, C., et al. (2005). Executive functions and methylphenidate response in subtypes of Attention-deficit/hyperactivity disorder. Biological Psychiatry, 57, 1452–1460.PubMedCrossRefGoogle Scholar
  54. Oosterlaan, J., Logan, G. D., & Sergeant, J. A. (1998). Response inhibition in AD/HD, CD, comorbid AD/HD+CD, anxious and control children: A meta-analysis of studies with the stop task. Journal of Child Psychology and Psychiatry, 39, 411–425.PubMedCrossRefGoogle Scholar
  55. Patterson, C., & Newman, J. P. (1993). Reflectivity and learning from aversive events: Toward a psychological mechanism for the syndromes of disinhibition. Psychological Review, 100, 716–736.PubMedCrossRefGoogle Scholar
  56. Pelham, W. E. (2001). Are ADHD/I and ADHD/C the same or different? Does it matter? Clinical Psychology: Science and Practice, 8, 502–506.CrossRefGoogle Scholar
  57. Pennington, B. E., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, 37, 51–87.PubMedCrossRefGoogle Scholar
  58. Pliszka, S. R., Bocherding, S. H., Spratley, K., Leon, S., & Irick, S. (1997). Measuring inhibitory control in children. Journal of Developmental and Behavioral Pediatrics, 18, 254–259.PubMedCrossRefGoogle Scholar
  59. Pliszka, S. R., Hatch, J. P., Bocherding, S. H., & Rogeness, G. A. (1993). Classical conditioning in children with attention deficit hyperactivity disorder (ADHD) and anxiety disorders: A test of Quay’s model. Journal of Abnormal Child Psychology, 21, 411–523.PubMedCrossRefGoogle Scholar
  60. Pfiffner, L. J., Mikami, A. Y., Huang-Pollock, C. L., Easterlin, B., Zalecki, C., & McBurnett, K. (2007). A randomized, controlled trial of integrated home-school behavioral treatment for ADHD, predominantly inattentive type. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1041–1050.PubMedCrossRefGoogle Scholar
  61. Quay, H. (1988). The behavioral reward and inhibition system in childhood behavior disorder. Elmsford, NY: Pergamon.Google Scholar
  62. Quay, H. C. (1997). Inhibition and attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 25, 7–13.PubMedCrossRefGoogle Scholar
  63. Rey, J. M., Schrader, E., & Morris-Yates, A. (1992). Parent-child agreement on children’s behaviours reported by the Child Behavior Checklist (CBCL). Journal of Adolescence, 15, 219–230.PubMedCrossRefGoogle Scholar
  64. Riccio, C. A., Homack, S., Jarratt-Pizzitola, K., & Wolfe, M. E. (2006). Differences in academic and executive function domains among children with ADHD predominantly inattentive and combined types. Archives of Clinical Neuropsychology, 21, 657–667.PubMedCrossRefGoogle Scholar
  65. Rommelse, N. N. J., Altink, M. E., Sonneville, L. M. J., Buschgens, C. J. M., Buitelaar, J., Oosterlaan, J., et al. (2007). Are motor inhibition and cognitive flexibility dead ends in ADHD? Journal of Abnormal Child Psychology, 35, 957–967.PubMedCrossRefGoogle Scholar
  66. Rowe, D. C., Stever, C., & Gard, J. M. C. (1998). The relation of the dopamine transporter gene (DAT1) to symptoms of internalizing disorders in children. Behavior Genetics, 28, 215–225.PubMedCrossRefGoogle Scholar
  67. Smoller, J. W., Biederman, J., Arbeitman, L., Doyle, A. E., Fagerness, J., Perlis, R. H., et al. (2006). Association between the 5HT1B receptor gene (HTR1B) and the inattentive subtype of ADHD. Biological Psychiatry, 59, 460–467.PubMedCrossRefGoogle Scholar
  68. Solanto, M. V., Gilbert, S. N., Raj, A., Zhu, J., Pope-Boyd, S., Stepak, B., et al. (2007). Neurocognitive functioning in AD/HD, predominantly inattentive and combined subtypes. Journal of Abnormal Child Psychology, 35, 729–744.PubMedCrossRefGoogle Scholar
  69. Weiss, M. D., Worling, D. E., & Wasdell, M. B. (2003). A chart review study of the Inattentive and Combined Types of ADHD. Journal of Attention Disorders, 7, 1–9.PubMedCrossRefGoogle Scholar
  70. Weller, E. B., Weller, R. A., Rooney, M. T., & Fristad, M. A. (1999). ChIPS. Washington, DC: American Psychiatric Association.Google Scholar
  71. Wilens, T., Pelham, W., Stein, M., Conners, C., Abikoff, H., Atkins, M., et al. (2003). ADHD treatment with once-daily OROS methylphenidate: Interim 12-month results from a long-term open-label study. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 424–433 (April).CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Karen J. Derefinko
    • 1
  • Zachary W. Adams
    • 1
  • Richard Milich
    • 1
  • Mark T. Fillmore
    • 1
  • Elizabeth P. Lorch
    • 1
  • Donald R. Lynam
    • 2
  1. 1.Department of PsychologyUniversity of KentuckyLexingtonUSA
  2. 2.Department of Psychological SciencesPurdue UniversityWest LafayetteUSA

Personalised recommendations