Journal of Abnormal Child Psychology

, Volume 46, Issue 4, pp 701–711 | Cite as

Processing Speed Predicts Behavioral Treatment Outcomes in Children with Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type

  • Christopher J. Adalio
  • Elizabeth B. Owens
  • Keith McBurnett
  • Stephen P. Hinshaw
  • Linda J. PfiffnerEmail author


Neuropsychological functioning underlies behavioral symptoms of attention-deficit/hyperactivity disorder (ADHD). Children with all forms of ADHD are vulnerable to working memory deficits and children presenting with the inattentive form of ADHD (ADHD-I) appear particularly vulnerable to processing speed deficits. As ADHD-I is the most common form of ADHD presented by children in community settings, it is important to consider how treatment interventions for children with ADHD-I may be affected by deficits in processing speed and working memory. We utilize data collected from 199 children with ADHD-I, aged 7 to 11 years, who participated in a randomized clinical trial of a psychosocial-behavioral intervention. Our aims are first to determine whether processing speed or working memory predict treatment outcomes in ADHD-I symptom severity, and second whether they moderate treatment effects on ADHD-I symptom severity. Results of linear regression analyses reveal that baseline processing speed significantly predicts posttreatment ADHD-I symptom severity when controlling for baseline ADHD-I symptom severity, such that better processing speed is associated with greater symptom improvement. However, predictive effects of working memory and moderation effects of both working memory and processing speed are not supported in the present study. We discuss study limitations and implications of the relation between processing speed and treatment benefits from psychosocial treatments for children with ADHD-I.


ADHD Inattentiveness Processing speed Clinical trial Psychosocial intervention 


Compliance with Ethical Standards


This study was funded by the National Institute of Mental Health (MH077671).

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.CrossRefGoogle Scholar
  2. Araujo Jiménez, E. A., Jané Ballabriga, M. C., Martin, A. B., Arrufat, F. J., & Giacobo, R. S. (2015). Executive functioning in children and adolescents with symptoms of sluggish cognitive tempo and ADHD. Journal of Attention Disorders, 19, 507–514. doi: 10.1177/1087054713495442.CrossRefPubMedGoogle Scholar
  3. Arnett, A. B., Pennington, B. F., Willcutt, E. G., DeFries, J. C., & Olson, R. K. (2015). Sex differences in ADHD symptom severity. Journal of Child Psychology and Psychiatry, 56, 632–639. doi: 10.1111/jcpp.12337.CrossRefPubMedGoogle Scholar
  4. Barkley, R. A. (1987). Defiant children: A clinician's manual for parent training. New York: Guilford Press.Google Scholar
  5. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94. doi: 10.1037/0033-2909.121.1.65.CrossRefPubMedGoogle Scholar
  6. Barkley, R. A. (2014). Sluggish cognitive tempo (concentration deficit disorder?): Current status, future directions, and a plea to change the name. Journal of Abnormal Child Psychology, 42, 117–125. doi: 10.1007/s10802-013-9824-y.CrossRefPubMedGoogle Scholar
  7. Bauermeister, J. J., Barkley, R. A., Bauermeister, J. A., Martínez, J. V., & McBurnett, K. (2012). Validity of the sluggish cognitive tempo, inattention, and hyperactivity symptom dimensions: Neuropsychological and psychosocial correlates. Journal of Abnormal Child Psychology, 40, 683–697. doi: 10.1007/s10802-011-9602-7.CrossRefPubMedGoogle Scholar
  8. Bidwell, L. C., Willcutt, E. G., DeFries, J. C., & Pennington, B. F. (2007). Testing for neuropsychological endophenotypes in siblings discordant for attention-deficit/hyperactivity disorder. Biological Psychiatry, 62, 991–998. doi: 10.1016/j.biopsych.2007.04.003.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Biederman, J., Seidman, L. J., Petty, C. R., Fried, R., Doyle, A. E., Cohen, D. R., et al. (2008). Effects of stimulant medication on neuropsychological functioning in young adults with attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 69, 1150–1156. doi: 10.4088/JCP.v69n0715.CrossRefPubMedGoogle Scholar
  10. Bink, M., van Nieuwenhuizen, C., Popma, A., Bongers, I. L., & van Boxtel, G. J. M. (2014). Neurocognitive effects of neurofeedback in adolescents with ADHD: A randomized controlled trial. Journal of Clinical Psychiatry, 75, 535–542. doi: 10.4088/JCP.13m08590.CrossRefPubMedGoogle Scholar
  11. Burge, W. K., Ross, L. A., Amthor, F. R., Mitchell, W. G., Zotov, A., & Visscher, K. M. (2013). Processing speed training increases the efficiency of attentional resource allocation in young adults. Frontiers in Human Neuroscience, 7, 1–7. doi: 10.3389/fnhum.2013.00684.CrossRefGoogle Scholar
  12. Buschkuehl, M., Jaeggi, S. M., & Jonides, J. (2012). Neuronal effects following working memory training. Developmental Cognitive Neuroscience, 2, S167–S179. doi: 10.1016/j.dcn.2011.10.001.CrossRefPubMedGoogle Scholar
  13. Cortese, S., Ferrin, M., Brandeis, D., Buitelaar, J., Daley, D., Dittmann, R. W., & Sonuga-Barke, E. J. S. (2015). Cognitive training for attention-deficit/hyperactivity disorder: Meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child & Adolescent Psychiatry, 54, 164–174. doi: 10.1016/j.jaac.2014.12.010.CrossRefGoogle Scholar
  14. Dennis, M., Francis, D. J., Cirino, P. T., Schachar, R., Barnes, M. A., & Fletcher, J. M. (2009). Why IQ is not a covariate in cognitive studies of neurodevelopmental disorders. Journal of the International Neuropsychological Society, 15, 331–343. doi: 10.1017/S1355617709090481.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Fabiano, G. A., Pelham Jr., W. E., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A., & O'Connor, B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29, 129–140. doi: 10.1016/j.cpr.2008.11.001.CrossRefPubMedGoogle Scholar
  16. Fabiano, G. A., Vujnovic, R. K., Pelham, W. E., Waschbusch, D. A., Massetti, G. M., Pariseau, M. E., & Volker, M. (2010). Enhancing the effectiveness of special education programming for children with attention deficit hyperactivity disorder using a daily report card. School Psychology Review, 39, 219–239 Retrieved from Scholar
  17. Finke, K., Dodds, C. M., Bublak, P., Regenthal, R., Baumann, F., Manly, T., & Müller, U. (2010). Effects of modafinil and methylphenidate on visual attention capacity: A TVA-based study. Psychopharmacology, 210, 317–329. doi: 10.1007/s00213-010-1823-x.CrossRefPubMedGoogle Scholar
  18. Forehand, R., & McMahon, R. (1981). Helping the noncompliant child: A clinician’s guide to parent training. New York: Guilford Press.Google Scholar
  19. Gadow, K. D., & Sprafkin, J. (1994). Child symptom inventories manual. Stony Brook, NY: Checkmate Plus.Google Scholar
  20. Graziano, P. A., Geffken, G. R., & Lall, A. S. (2011). Heterogeneity in the pharmacological treatment of children with ADHD: Cognitive, behavioral, and social functioning differences. Journal of Attention Disorders, 15, 382–391. doi: 10.1177/1087054710367772.CrossRefPubMedGoogle Scholar
  21. Hellwig-Brida, S., Daseking, M., Petermann, F., & Goldbeck, L. (2010). Intelligenz- und aufmerksamkeitsleistungen von jungen mit ADHS [Components of intelligence and attention in boys with ADHD]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 58, 299–308. doi: 10.1024/1661-4747/a000040.CrossRefGoogle Scholar
  22. Hunt, M. G., Bienstock, S. W., & Qiang, J. K. (2012). Effects of diurnal variation on the test of variables of attention performance in young adults with attention-deficit/hyperactivity disorder. Psychological Assessment, 24, 166–172. doi: 10.1037/a0025233.CrossRefPubMedGoogle Scholar
  23. Jak, A. J., Seelye, A. M., & Jurick, S. M. (2013). Crosswords to computers: A critical review of popular approaches to cognitive enhancement. Neuropsychology Review, 23, 13–26. doi: 10.1007/s11065-013-9226-5.CrossRefPubMedGoogle Scholar
  24. Kaufman, J., Birmaher, B., Brent, D., & Rao, U. (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 & Adolescent Psychiatry, 36, 980–988. doi: 10.1097/00004583-199707000-00021.CrossRefGoogle Scholar
  25. Konrad, K., & Eickhoff, S. B. (2010). Is the ADHD brain wired differently? A review on structural and functional connectivity in attention deficit hyperactivity disorder. Human Brain Mapping, 31, 904–916. doi: 10.1002/hbm.21058.CrossRefPubMedGoogle Scholar
  26. Lajoie, G., Anderson, V., Anderson, P., Tucker, A. R., Robertson, I. H., & Manly, T. (2005). Effects of methylphenidate on attention skills in children with attention deficit/hyperactivity disorder. Brain Impairment, 6, 21–32. doi: 10.1375/brim. Scholar
  27. Lee, S., Burns, G. L., Snell, J., & McBurnett, K. (2014). Validity of the sluggish cognitive tempo symptom dimension in children: Sluggish cognitive tempo and ADHD-inattention as distinct symptom dimensions. Journal of Abnormal Child Psychology, 42, 7–19. doi: 10.1007/s10802-013-9714-3.CrossRefPubMedGoogle Scholar
  28. Lei, D., Ma, J., Du, X., Shen, G., Jin, X., & Gong, Q. (2014). Microstructural abnormalities in the combined and inattentive subtypes of attention deficit hyperactivity disorder: A diffusion tensor imaging study. Scientific Reports, 4, 1–7. doi: 10.1038/srep06875.Google Scholar
  29. Mackey, A. P., Hill, S. S., Stone, S. I., & Bunge, S. A. (2011). Differential effects of reasoning and speed training in children. Developmental Science, 14, 582–590. doi: 10.1111/j.1467-7687.2010.01005.x.CrossRefPubMedGoogle Scholar
  30. 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. doi: 10.1080/13803390500205700.CrossRefPubMedGoogle Scholar
  31. Mayes, S. D., Calhoun, S. L., Chase, G. A., Mink, D. M., & Stagg, R. E. (2009). ADHD subtypes and co-occurring anxiety, depression, and oppositional-defiant disorder: Differences in Gordon diagnostic system and Wechsler working memory and processing speed index scores. Journal of Attention Disorders, 12, 540–550. doi: 10.1177/1087054708320402.CrossRefPubMedGoogle Scholar
  32. McBurnett, K., Pfiffner, L. J., & Frick, P. J. (2001). Symptom properties as a function of ADHD type: An argument for continued study of sluggish cognitive tempo. Journal of Abnormal Child Psychology, 29, 207–213. doi: 10.1023/A:1010377530749.CrossRefPubMedGoogle Scholar
  33. Nielsen, N. P., & Wiig, E. H. (2011). AQT cognitive speed and processing efficiency differentiate adults with and without ADHD: A preliminary study. International Journal of Psychiatry in Clinical Practice, 15, 219–227. doi: 10.3109/13651501.2011.582538.CrossRefPubMedGoogle Scholar
  34. Nigg, J. T., Stavro, G., Ettenhofer, M., Hambrick, D. Z., Miller, T., & Henderson, J. M. (2005). Executive functions and ADHD in adults: Evidence for selective effects on ADHD symptom domains. Journal of Abnormal Psychology, 114, 706–717. doi: 10.1037/0021-843X.114.3.706.CrossRefPubMedGoogle Scholar
  35. Pelham Jr., W. E., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 37, 184–214. doi: 10.1080/15374410701818681.CrossRefPubMedGoogle Scholar
  36. Pfiffner, L. J. (2011). All about ADHD: The complete practical guide for classroom teachers (2nd ed.). New York: Scholastic.Google Scholar
  37. Pfiffner, L. J., & McBurnett, K. (1997). Social skills training with parent generalization: Treatment effects for children with attention deficit disorder. Journal of Consulting and Clinical Psychology, 65, 749–757. doi: 10.1037/0022-006X.65.5.749.CrossRefPubMedGoogle Scholar
  38. Pfiffner, L. J., Barkley, R. A., & DuPaul, G. (2006). Treatment of ADHD in school settings. In R. A. Barkley (Ed.), Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed., pp. 547–589). New York: Guilford Press.Google Scholar
  39. Pfiffner, L. J., Hinshaw, S. P., Owens, E. B., Zalecki, C., Kaiser, N., Villodas, M., & McBurnett, K. (2014). A two-site randomized clinical trial of integrated psychosocial treatment for ADHD-inattentive type. Journal of Consulting and Clinical Psychology, 82, 1115–1127. doi: 10.1037/a0036887.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Rossi, A. S. U., de Moura, L. M., de Mello, C. B., de Souza, A. A. L., Muszkat, M., & Bueno, O. F. A. (2015). Attentional profiles and white matter correlates in attention-deficit/hyperactivity disorder predominantly inattentive type. Frontiers in Psychiatry, 6, 1–10. doi: 10.3389/fpsyt.2015.00122.CrossRefGoogle Scholar
  41. Sonuga-Barke, E., Bitsakou, P., & Thompson, M. (2010). Beyond the dual pathway model: Evidence for the dissociation of timing, inhibitory, and delay-related impairments in attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 345–355. doi: 10.1097/00004583-201004000-00009.Google Scholar
  42. Stevens, M. C., Gaynor, A., Bessette, K. L., & Pearlson, G. D. (2016). A preliminary study of the effects of working memory training on brain function. Brain Imaging and Behavior, 10, 387–407. doi: 10.1007/s11682-015-9416-2.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Takeuchi, H., & Kawashima, R. (2012). Effects of processing speed training on cognitive functions and neural systems. Reviews in the Neurosciences, 23, 289–301. doi: 10.1515/revneuro-2012-0035.CrossRefPubMedGoogle Scholar
  44. Takeuchi, H., Taki, Y., & Kawashima, R. (2010). Effects of working memory training on cognitive functions and neural systems. Reviews in the Neurosciences, 21, 427–449. doi: 10.1515/REVNEURO.2010.21.6.427.CrossRefPubMedGoogle Scholar
  45. Thaler, N. S., Bello, D. T., & Etcoff, L. M. (2013). WISC-IV profiles are associated with differences in symptomatology and outcome in children with ADHD. Journal of Attention Disorders, 17, 291–301. doi: 10.1177/1087054711428806.CrossRefPubMedGoogle Scholar
  46. Todd, R. D., Rasmussen, E. R., Wood, C., Levy, F., & Hay, D. A. (2004). Should sluggish cognitive tempo symptoms be included in the diagnosis of attention-deficit/hyperactivity disorder? Journal of the American Academy of Child & Adolescent Psychiatry, 43, 588–597. doi: 10.1097/00004583-200405000-00012.CrossRefGoogle Scholar
  47. van Ewijk, H., Heslenfeld, D. J., Zwiers, M. P., Buitelaar, J. K., & Oosterlaan, J. (2012). Diffusion tensor imaging in attention deficit/hyperactivity disorder: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 36, 1093–1106. doi: 10.1016/j.neubiorev.2012.01.003.CrossRefPubMedGoogle Scholar
  48. Waldman, I. D. (2005). Statistical approaches to complex phenotypes: Evaluating neuropsychological endophenotypes for attention-deficit/hyperactivity disorder. Biological Psychiatry, 57, 1347–1356. doi: 10.1016/j.biopsych.2005.03.002.CrossRefPubMedGoogle Scholar
  49. Wechsler, D. (2003a). Wechsler intelligence scale for children–fourth edition. San Antonio, TX: Psychological Corporation.Google Scholar
  50. Wechsler, D. (2003b). WISC-IV technical and interpretive manual. San Antonio, TX: Psychological Corporation.Google Scholar
  51. Weiler, M. D., Bernstein, J. H., Bellinger, D. C., & Waber, D. P. (2000). Processing speed in children with attention deficit/hyperactivity disorder, inattentive type. Child Neuropsychology, 6, 218–234. doi: 10.1076/chin. Scholar
  52. Weiler, M. D., Bernstein, J. H., Bellinger, D., & Waber, D. P. (2002). Information processing deficits in children with attention-deficit/hyperactivity disorder, inattentive type, and children with reading disability. Journal of Learning Disabilities, 35, 448–461. doi: 10.1177/00222194020350050501.CrossRefPubMedGoogle Scholar
  53. Wells, K. C., Abikoff, H., Abramowitz, A., Courtney, M., Cousins, L., Del Carmen, R., & Pfiffner, L. (1996). Parent training for attention deficit hyperactivity disorder: MTA study manual. Durham, NC: Duke University Medical Center.Google Scholar
  54. Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9, 490–499. doi: 10.1007/s13311-012-0135-8.CrossRefPubMedPubMedCentralGoogle Scholar
  55. Willcutt, E. G., Chhabildas, N., Kinnear, M., DeFries, J. C., Olson, R. K., Leopold, D. R., & Pennington, B. F. (2014). The internal and external validity of sluggish cognitive tempo and its relation with DSM–IV ADHD. Journal of Abnormal Child Psychology, 42, 21–35. doi: 10.1007/s10802-013-9800-6.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Christopher J. Adalio
    • 1
  • Elizabeth B. Owens
    • 1
  • Keith McBurnett
    • 2
  • Stephen P. Hinshaw
    • 1
    • 2
  • Linda J. Pfiffner
    • 2
    Email author
  1. 1.Department of PsychologyUniversity of California, BerkeleyBerkeleyUSA
  2. 2.Department of PsychiatryUniversity of California, San FranciscoSan FranciscoUSA

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