Competing Core Processes in Attention-Deficit/Hyperactivity Disorder (ADHD): Do Working Memory Deficiencies Underlie Behavioral Inhibition Deficits?

Abstract

The current study examined competing predictions of the working memory and behavioral inhibition models of ADHD. Behavioral inhibition was measured using a conventional stop-signal task, and central executive, phonological, and visuospatial working memory components (Baddeley 2007) were assessed in 14 children with ADHD and 13 typically developing (TD) children. Bootstrapped mediation analyses revealed that the visuospatial working memory system and central executive both mediated the relationship between group membership (ADHD, TD) and stop-signal task performance. Conversely, stop-signal task performance mediated the relationship between group membership and central executive processes, but was unable to account for the phonological and visuospatial storage/rehearsal deficits consistently found in children with ADHD. Comparison of effect size estimates for both models suggested that working memory deficits may underlie impaired stop-signal task performance in children with ADHD. The current findings therefore challenge existing models of ADHD that describe behavioral inhibition as a core deficit of the disorder.

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Fig. 1

Notes

  1. 1.

    Lee et al. (2004) tested the divergent predictions of the working memory (Rapport et al. 2008b) and inhibition (Barkley 2006) models of ADHD, and found that working memory mediated the relationship between cognitive disinhibition and teacher-reported attention problems. The distinction between cognitive and behavioral inhibition, however, is well documented and suggests that these findings may only generalize to a select component of the inhibition model (Nigg 2001).

  2. 2.

    One typically developing child had elevated parent ratings on three CBCL scales. K-SADS interview with parent and child revealed that these endorsements were highly specific to a recent parent-child interaction. CSI—Parent severity scores for this child were in the normal range.

  3. 3.

    SSRT is unobservable and obtained by subtracting participants’ mean SSD from MRT (SSRT=MRT-SSD).

  4. 4.

    All mediation analyses were also completed with age as a covariate. Only the simple models without covariates were reported, however, since the pattern of results did not change.

  5. 5.

    All mediation analyses were also examined with the conventional method outlined by Baron and Kenney (1986). The overall pattern of results did not change. The VS composite score and CE fully mediated SSRT, while SSRT only partially mediated the VS composite score and CE.

References

  1. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles. Burlington: University of Vermont Research Center for Children, Youth, & Families.

    Google Scholar 

  2. Ackerman, P. L., Beier, M. E., & Boyle, M. O. (2005). Working memory and intelligence: the same or different constructs? Psychological Bulletin, 131, 30–60.

    Article  PubMed  Google Scholar 

  3. Alderson, R. M., Rapport, M. D., & Kofler, M. J. (2007). Attention-deficit/hyperactivity disorder and behavioral inhibition: a meta-analytic review of the stop-signal paradigm. Journal of Abnormal Child Psychology, 35, 745–758.

    Article  PubMed  Google Scholar 

  4. Alderson, R. M., Rapport, M. D., Sarver, D. E., & Kofler, M. J. (2008). ADHD and behavioral inhibition: a re-examination of the stop-signal task. Journal of Abnormal Child Psychology, 36, 989–998.

    Article  PubMed  Google Scholar 

  5. Alloway, T. P., Gathercole, S. E., & Pickering, S. J. (2006). Verbal and visual spatial short-term and working memory in children: are they separable? Child Development, 77, 1698–1716.

    Article  PubMed  Google Scholar 

  6. Awh, E., & Jonides, J. (2001). Overlapping mechanisms of attention and working memory. Trends in Cognitive Sciences, 5, 119–126.

    Article  PubMed  Google Scholar 

  7. Baddeley, A. (2007). Working memory, thought, and action. New York: Oxford University Press.

    Google Scholar 

  8. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.

    Article  PubMed  Google Scholar 

  9. Barkley, R. A. (2006). Attention deficit hyperactivity disorder: handbook for diagnosis and treatment (3rd ed.). New York: The Guilford Press.

    Google Scholar 

  10. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  PubMed  Google Scholar 

  11. Brocki, K. C., Randall, K. D., Bohlin, G., & Kerns, K. A. (2008). Working memory in school-aged children with attention-deficit/hyperactivity disorder combined type: are deficits modality specific and are they independent of impaired inhibitory control? Journal of Clinical and Experimental Neuropsychology, 30, 749–759.

    Article  PubMed  Google Scholar 

  12. Castellanos, F. X., & Tannock, R. (2002). Neuroscience of attention-deficit/hyperactivity disorder: the search for endophenotypes. Nature Reviews Neuroscience, 3, 617–628.

    PubMed  Google Scholar 

  13. Clark, L., Blackwell, A. D., Aron, A. R., Turner, D. C., Dowson, J., Robbins, T. W., et al. (2007). Association between response inhibition and working memory in adult ADHD: a link to right frontal cortex pathology? Biological Psychiatry, 61, 1395–1401.

    Article  PubMed  Google Scholar 

  14. Colom, R., Abad, F., Rebollo, I., & Shih, P. C. (2005). Memory span and general intelligence: a latent variable approach. Intelligence, 32, 623–642.

    Article  Google Scholar 

  15. Conway, A. R. A., Kane, M. J., Bunting, M. F., Hambrick, D. Z., Wilhelm, O., & Engle, R. W. (2005). Working memory span tasks: a methodological review and user’s guide. Psychonomic Bulletin & Review, 12, 769–786.

    Google Scholar 

  16. Crosbie, J., Pérusse, D., Barr, C. L., & Schachar, R. J. (2008). Validating psychiatric endophenotypes: inhibitory control and attention deficit hyperactivity disorder. Neuroscience and Biobehavioral Reviews, 32, 40–55.

    Article  PubMed  Google Scholar 

  17. Cumming, G., & Finch, S. (2005). Inference by eye: confidence intervals and how to read pictures of data. American Psychologist, 60(2), 170–180.

    Article  PubMed  Google Scholar 

  18. Efron, B., & Tibshirani, R. J. (1993). An introduction to the bootstrap. Boca Raton: Chapman & Hall.

    Google Scholar 

  19. Engle, R. W., Kane, M. J., & Tuholski, S. W. (1999). Individual differences in working memory capacity and what they tell us about controlled attention, general fluid intelligence, and functions of the prefrontal cortex. In A. Miyake & P. Shah (Eds.), Models of working memory: Mechanisms of active maintenance and executive control (pp. 102–134). New York: Cambridge University Press.

    Google Scholar 

  20. Fassbender, C., & Schweitzer, J. B. (2006). Is there evidence for neural compensation in attention deficit hyperactivity disorder? A review of the functional neuroimaging literature. Clinical Psychology Review, 26, 445–465.

    Article  PubMed  Google Scholar 

  21. Gadow, K. D., Sprafkin, J., & Salisbury, H. (2004). Further validity evidence for the teacher version of the Child Symptom Inventory-4. School Psychology Quarterly, 19, 50–71.

    Article  Google Scholar 

  22. Garavan, H. (1998). Serial attention within working memory. Memory & Cognition, 26, 263–276.

    Google Scholar 

  23. Hollingshead, A. B. (1975). Four-factor index of social status. Unpublished manuscript. Department of Sociology, Yale University.

  24. Huang-Pollock, C. L., Carr, T. H., & Nigg, J. T. (2002). Development of selective attention: perceptual load influences early versus late attentional selection in children and adults. Developmental Psychology, 38, 363–375.

    Article  PubMed  Google Scholar 

  25. Huizenga, H. M., van Bers, B., Plat, J., van den Wildenberg, W., & van der Molen, M. W. (2009). Task complexity enhances response inhibition deficits in childhood and adolescent attention-deficit/hyperactivity disorder: a meta-regression analysis. Biological Psychiatry, 65, 39–45.

    Article  PubMed  Google Scholar 

  26. Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.

    Article  PubMed  Google Scholar 

  27. Klingberg, T., Forssberg, H., & Westerberg, H. (2002). Training of working memory in children with ADHD. Journal of Clinical and Experimental Neuropsychology, 24, 781–791.

    Article  PubMed  Google Scholar 

  28. Klorman, R., Hazel-Fernandez, L. A., Shaywitz, S. E., Fletcher, J. M., Marchione, K. E., Holahan, J. M., et al. (1999). Executive functioning deficits in attention-deficit/hyperactivity disorder are independent of oppositional defiant or reading disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1148–1155.

    Article  PubMed  Google Scholar 

  29. Kofler, M. J., Rapport, M. D., Bolden, J., Sarver, D. E., & Raiker, J. S. (2009). ADHD and working memory: The impact of central executive deficits and overwhelming storage/rehearsal capacity on observed inattentive behavior Journal of Abnormal Child Psychology. doi:10.1007/s10802-009-9357-6.

  30. Lee, D., Riccio, C. A., & Hynd, G. W. (2004). The role of executive functions in attention deficit hyperactivity disorder: testing predictions from two models. Canadian Journal of School Psychology, 19, 167–189.

    Article  Google Scholar 

  31. Lijffijt, M., Kenemans, 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.

    Article  PubMed  Google Scholar 

  32. Logan, G. D., Cowan, W. B., & Davis, K. A. (1984). On the ability to inhibit simple and choice reaction time responses: a model and a method. Journal of Experimental Psychology, 10, 276–291.

    PubMed  Google Scholar 

  33. Martinussen, R., & Tannock, R. (2006). Working memory impairments in children with attention-deficit hyperactivity disorder with and without comorbid language learning disorders. Journal of Clinical and Experimental Neuropsychology, 28, 1073–1094.

    Article  PubMed  Google Scholar 

  34. Martinussen, R., Hayden, J., Hogg-Johnson, S., & Tannock, R. (2005). A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 377–384.

    Article  PubMed  Google Scholar 

  35. Marzocchi, G. M., Oosterlaan, J., Zuddas, A., Cavolina, P., Geurts, H., Redigolo, D., et al. (2008). Contrasting deficits on executive functions between ADHD and reading disabled children. Journal of Child Psychology and Psychiatry, 49, 543–552.

    Article  PubMed  Google Scholar 

  36. Mullane, J. C., & Corkum, P. V. (2007). The relationship between working memory, inhibition, and performance on the Wisconsin Card Sorting Test in children with and without ADHD. Journal of Psychoeducational Assessment, 25, 211–221.

    Article  Google Scholar 

  37. Oberauer, K. (2003). Selective attention to elements in working memory. Experimental Psychology, 50, 257–269.

    PubMed  Google Scholar 

  38. Pelham, W. E., Fabiano, G. A., & Massetti, G. M. (2005). Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34, 449–476.

    Article  PubMed  Google Scholar 

  39. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36, 717–731.

    Google Scholar 

  40. Rapport, M. D., Chung, K., Shore, G., & Isaacs, P. (2001). A conceptual model of child psychopathology: implications for understanding attention deficit hyperactivity disorder and treatment efficacy. Journal of Clinical Child Psychology, 30, 48–58.

    Article  PubMed  Google Scholar 

  41. Rapport, M. D., Alderson, R. M., Kofler, M. J., Sarver, D. E., Bolden, J., & Sims, V. (2008a). Working memory deficit in boys with attention-deficit/hyperactivity disorder (ADHD): the contribution of the central executive and subsystem processes. Journal of Abnormal Child Psychology, 36, 825–837.

    Article  PubMed  Google Scholar 

  42. Rapport, M. D., Kofler, M. J., Alderson, R. M., & Raiker, J. S. (2008b). Attention-deficit/hyperactivity disorder. In M. Hersen & D. Reitman (Eds.), Handbook of psychological assessment, case conceptualization and treatment (Vol. 2): Children and adolescents (pp. 349–404). NJ: Wiley & Sons.

    Google Scholar 

  43. Rapport, M. D., Bolden, J., Kofler, M. J., Sarver, D. E., Raiker, J. S., & Alderson, R. M. (2009). Hyperactivity in boys with attention-deficit/hyperactivity disorder (ADHD): a ubiquitous core symptom or manifestation of working memory deficits? Journal of Abnormal Child Psychology, 37, 521–534.

    Article  PubMed  Google Scholar 

  44. Schachar, R., Mota, V., Logan, G., Tannock, R., & Klim, P. (2000). Confirmation of an inhibitory control deficit in attention-deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 28, 227–235.

    Article  PubMed  Google Scholar 

  45. Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychological Methods, 7, 422–445.

    Article  PubMed  Google Scholar 

  46. Smith, E. E., Jonides, J., & Koeppe, R. A. (1996). Dissociating verbal and spatial working memory using PET. Cerebral Cortex, 6, 11–20.

    Article  PubMed  Google Scholar 

  47. Sonuga-Barke, E. J. (2002). Psychological homogeneity in AD/HD—A dual pathway model of behaviour and cognition. Behavioural Brain Research, 130, 29–36.

    Article  PubMed  Google Scholar 

  48. Sonuga-Barke, E. J. S., Dalen, L., Daley, D., & Remington, B. (2002). Are planning, working memory, and inhibition associated with individual differences in preschool ADHD symptoms? Developmental Neuropsychology, 21, 255–272.

    Article  PubMed  Google Scholar 

  49. SuperLab Pro (Version 2) [Computer program]. (2002). San Pedro, CA. (http://www.cedrus.com): Cedrus Corporation.

  50. Swanson, L., & Kim, K. (2007). Working memory, short-term memory, and naming speed as predictors of children’s mathematical performance. Intelligence, 35, 151–168.

    Article  Google Scholar 

  51. Wechsler, D. (1991). Wechsler intelligence scale for children (3rd ed.). San Antonio: Psychological Corporation.

    Google Scholar 

  52. Wechsler, D. (2003). Wechsler intelligence scale for children (4th ed.). San Antonio: Psychological Corporation.

    Google Scholar 

  53. Wilens, T. E., Biederman, J., Brown, S., Tanquay, S., Monuteaux, M. C., Blake, C., et al. (2002). Psychiatric comorbidity and functioning in clinically referred preschool children and school-age youths with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 262–268.

    Article  PubMed  Google Scholar 

  54. Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of attention deficit/hyperactivity disorder: a meta-analytic review. Biological Psychiatry, 57, 1336–1346.

    Article  PubMed  Google Scholar 

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Correspondence to R. Matt Alderson.

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Alderson, R.M., Rapport, M.D., Hudec, K.L. et al. Competing Core Processes in Attention-Deficit/Hyperactivity Disorder (ADHD): Do Working Memory Deficiencies Underlie Behavioral Inhibition Deficits?. J Abnorm Child Psychol 38, 497–507 (2010). https://doi.org/10.1007/s10802-010-9387-0

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Keywords

  • Attention-deficit/hyperactivity disorder
  • ADHD
  • Behavioral inhibition
  • Stop-signal task
  • Working memory