E-ISSN : 2733-4538
The current study presents an integrated executive function model that explains the interrelationships among deficits in two executive functions (working memory and inhibition), ADHD symptoms, and two conditions (reading difficulty and substance abuse) that are commonly comorbid with ADHD in adulthood. The validity of the integrated model was tested using structural equation modeling with an adult sample consisting of consecutive referrals to a university-based research project. The final model suggested that working memory problems directly contribute to reading difficulty as well as to inattentive symptoms in adults. Direct contributions of inhibition to ADHD symptoms were not supported. However, ADHD symptoms had direct and indirect contributions to substance abuse symptoms. Current findings suggest the crucial role of working memory in the manifestation of ADHD symptoms and comorbid reading problems and also suggest ADHD symptoms' contribution to the development of adult substance abuse. These findings were interpreted as generally supporting the hypothesis of the developmental heterogeneity of executive function profiles associated with the manifestation of ADHD symptoms and comorbidities in adulthood.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.) text revision (DSM-IV-TR). Washington DC: American Psychiatric Association.
Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103, 411-423.
Arbuthnott, K., & Frank, J. (2000). Trail Making Test, Part B as a measure of executive control: Validation using a set-switching paradigm. Journal of Clinical and Experimental Neuropsychology, 22, 518-528.
Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: Handbook for diagnosis and treatment (3rd ed.). New York: Guilford.
Barnett, R., Maruff, P., Vance, A., Luk, E. S. L., Costin, J., Wood, C., & Pantelis, C. (2001). Abnormal execution function in attention deficit hyperactivity disorder: The effect of stimulant medication and age on spatial working memory. Psychological Medicine, 31, 1107-1115.
Biederman, J., Wilens, T. E., & Mick E. (1997). Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 21-29.
Biederman, J., Wilens, T., Mick, E., Spencer, T., & Faraone, S. V. (1999). Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. Pediatrics, 104. e20.
Bollen, K. A. (1989). Structural equations with latent variables. New York: Wiley.
Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp.136-162). Newbury Park, CA: Sage.
Castellanos, F. X., & Tannock, R. (2002). Neuroscience of attention deficit/hyperactivity disorder: The search for endophenotypes. Nature Reviews Neuroscience, 3, 617-628.
Chhabildas, N., Pennington, B. F., & Willcutt, E. G. (2001). A comparison of the neuropsychological profiles of the DSM-IV subtypes of ADHD. Journal of Abnormal Child Psychology, 29, 529-540.
Conners, C. K. (1999). The Conners Continuous Performance Test - Ⅱ. North Tonawanda, NY: Multi-Health Systems.
Conners, C. K., Erhardt, D., & Sparrow, E. (1997). Conners Adult ADHD Rating Scales (CAARS). North Tonawanda, NY: Multi- Health Systems, Inc.
Corbett, B., & Stanczak, D. E. (1999). Neuropsychological performance of adults evidencing attention-deficit hyperactivity disorder. Archives of Clinical Neuropsychology, 14, 373-387.
de Jong, P. F. (1998). Working memory deficits of reading disabled children. Journal of Experimental Child Psychology, 70, 75-96.
DuPaul, G. J., Anastopoulos, A. D., Shelton, T. L., Guevremont, D. C., & Metevia, L. (1992). Multimethod assessment of attention deficit hyperactivity disorder: The diagnostic utility of clinic-based tests. Journal of Clinical Child Psychology, 21, 394-402.
Eiraldi, R. B., Power, T. J., & Nezu, C. M. (1997). Patterns of comorbidity associated with subtypes of attention deficit hyperactivity disorder among 6-to 12-year-old children. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 503-514.
Epstein, J. N., Conners, C. K., Sitarenios, G., & Erhardt, D. (1998). Continuous performance test results of adults with attention deficit hyperactivity disorder. The Clinical Neuropsychologist, 12, 155-168.
Farone, S. V., Biederman, J., Feighner, J. A., & Monuteaux, M. C. (2000). Assessing symptoms of attention deficit hyperactivity disorder in children and adults: which is more valid? Journal of Consulting and Clinical Psychology, 68, 830-842.
Fischer, M., Barkley, R. A., Smallish, L., & Fletcher, K. (2005). Executive functioning in hyperactive children as young adults: Attention, inhibition, response perseveration, and the impact of comorbidity. Developmental Neuropsychology, 27, 107-133.
Gadow, K. D., Nolan, E. E., Litcher, L., Carlson, G. A., Panina, N., Golovakha, E., Sprafkin, J., & Broment, E. J. (2000). Comparison of attention deficit hyperactivity disorder symptoms subtypes in Ukrainian schoolchildren. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1520-1527.
Golden, C. J., & Freshwater, S. M. (2002). The Stoop Color and Word Test: A manual for clinical and experimental uses. Wood Dale, IL: Stoelting.
Gordon, M., McClure, F. D., & Post, E. M. (1986). Interpretive guide to the Gordon Diagnostic System. DeWitt, NY: Gordon Systems.
Hatcher, L. (1994). A step-by-step approach to using the SAS system for factor analysis and structural equation modeling. Cary, NC: SAS Institute Inc.
Hervey, A. S., Epstein, J. N., & Curry, J. F. (2004). Neuropsychology of adults with Attention Deficit Hyperactivity Disorder: A meta-analytic review. Neuropsychology, 18, 485-503.
Hitch, G. J. & McAuley, E. (1991). Working memory in children with specific arithmetical learning difficulties. British Journal of Psychology, 82, 375-386.
Houghton, S., Douglas, G., West, J., Whiting, K.,Wall, M., Langsford, S., Powell, L., & Caroll, A. (1999). Differential patterns of executive function in children with attention deficit hyperactivity disorder according to gender and subtype. Journal of Child Neurology, 14, 801-805.
Hu, L., & Bentler, P. M. (1995). Evaluating model fit. In R. H. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications (pp.76-99). Thousand Oaks, CA: Sage.
Isaki, E., & Plante, E. (1997). Short-term and working memory differences in language/ learning disabled and normal adults. Journal of Communication Disorders, 30, 427-438.
Jackson, D. L. (2001). Sample size and number of parameter estimates in maximum likelihood confirmatory factor analysis: A Monte Carlo investigation. Structural Equation Modeling, 8, 205-223.
Johnson, D. E., Epstein, J. N., Waid, L. R., Latham, P. K., Voronin, K. E., & Anton, R. F. (2001). Neuropsychological performance deficits in adults with attention deficit/hyperactivity disorder. Archives of Clinical Neuropsychology, 16, 587-604.
Karatekin, C. (2004). A test of the integrity of the components of Baddeley’s model of working memory in attention-deficit/ hyperactivity disorder (ADHD). Journal of Child Psychology and Psychiatry, 45. 912-926.
Kimberg, D, Y., & Farah, M. J. (1993). A unified account of cognitive impairments following frontal lobe damage: The role of working memory in complex, organized behavior. Journal of Experimental Psychology: General, 122, 411-428.
Kline, R. B. (1998). Principles and practice of structural equation modeling. New York: Guilford.
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.
Lehto, J. E., Juujarvi, P., Kooistra, L., & Pulkkinen, L. (2003). Dimensions of executive functioning: Evidence from children. British Journal of Developmental Psychology, 21, 59-80.
Lovejoy, D. W., Ball, J. D., & Keats, M. (1999). Neuropsychological performance of adults with attention deficit hyperactivity disorder (ADHD): Diagnostic classification estimates for measures of frontal lobe/executive functioning. Journal of the International Neuropsychology Society, 5, 222-233.
Lynskey, M. T. & Hall, W. (2001). Attention deficit hyperactivity disorder and substance use disorders: is there a causal link? Addiction, 96, 815-822.
Mannuzza, S., Klein, R., Bessler, A., Malloy, P., & LaPadula, M. (1993). Adult outcome of hyperactive boys: Educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry, 50, 565-576.
Mardia, K. V. (1970). Measures of multivariate skewness and kurtosis with applications. British Journal of Mathematical and Statistical Psychology, 28, 205-214.
Martinussen, R., Hayden, J., Hogg-Johnson, S., & Tannock, R. (2005). A meta-analysis of working memory impairment in children with attention-deficit hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 377-384.
McLean, A., Dowson, J., Toone, B., Young, S., Bazanis, E., Robbins, T. W., & Sahakian, B. J. (2004). Characteristic neurocognitive profile associated with adult attention-deficit/ hyperactivity disorder. Psychological Medicine, 34, 681-692.
Meltzer, L. (2007). Executive function in education: From theory to practice. New York, NY: Guilford Press.
Miller, G. F., Roberts, J., Brooks, M. K., & Lazowski, L. E. (1999). SASSI-3 user’s guide: A quick reference for administration and scoring. Bloomington, IN: Baugh Enterprises Inc.
Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41, 49-100.
Miyake, A., Friedman, N. P., Rettinger, D. A., Shah, P., & Hegarty, M. (2001). How are visuospatial working memory, executive functioning and spatial abilities related? A latent variable analysis. Journal of Experimental Psychology: General, 130, 621-640.
Modestine, J., Matutat, B., & Wurmle, O. (2001). Antecedents of opioid dependence and personality disorder: Attention deficit hyperactivity disorder and conduct disorder. European Archives of Psychiatry and Clinical Neuroscience, 21, 42-47.
Morgan, A. E., Hynd, G. W., Riccio, C. A., & Hall, J. (1996). Validity of DSM-IV ADHD predominantly inattentive and combined types: Relationship to previous DSM diagnoses/ subtype differences. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 325-333.
Morris, R. D. (1996). Relationships and distinctions among the concepts of attention, memory, and executive function: A developmental perspective. In G. R. Lyon, & N. A. Krasnegor (Eds.), Attention, memory, and executive function (pp.11-16). Baltimore, MD: Paul H. Brookes.
Nigg, J. T. (2001). Is ADHD a disinhibitory disorder? Psychological Bulletin, 127, 571-598.
Ossmann, J. M. & Mulligan, N. W. (2003). Inhibition and attention deficit hyperactivity in adults. American Journal of Psychology, 116, 35-50.
Passolunghi, M. C., & Siegel, L. S. (2001). Short-term memory, working memory, and inhibitory control in children with difficulties in arithmetic problem solving. Journal of Experimental Child Psychology, 80, 44-57.
Pennington, B. F. (1997). Dimensions of executive functions in normal and abnormal development. In N. A. Krasnegor, G. R. Lyon, & P. S. Goldman-Rakic (Eds.), Development of the prefrontal cortex: Evolution, neurobiology, and behavior (pp.265-281). Baltimore, MD: Paul H. Brookes.
Pennington, B. F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, 37, 51-87.
Pennington, B. F., Bennetto, L., McAleer, O. K., & Roberts, R. J., Jr. (1996): Executive functions and working memory: Theoretical measurement issues. In G. R. Lyon & N. A., Krasnegor (Eds.), Attention, memory and executive function (pp. 327-348). Baltimore, MD: Paul H. Brookes.
Rapport, M. D., Chung, K-M., 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.
Rapport, M. D., Kofler, M. J., Alderson, R. M., & Raiker, J. (2008). Attention-deficit/ hyperactivity disorder. In M. Hersen, & D. Reitman (Eds.) Handbook of psychological assessment, case conceptualization and treatment, volume 2: Children and adolescents (pp. 349-404). NJ: Wiley.
Reitan, R. M. (1992). Trail Making Test: Manual for administration and scoring. Tucson, AZ: Reitan Neuropsychological Laboratory.
Reynolds, C. R. (1997). Forward and backward memory span should not be combined for clinical analysis. Archives of Clinical Neuropsychology, 12, 29-40.
Roberts, R. J. & Pennington, B. F. (1996). An interactive framework for examining prefrontal cognitive processes. Developmental Neuropsychology, 12, 105-126.
Roberts, R. J., Hager, L. D. & Heron, C. (1994). Prefrontal cognitive processes: Working memory and inhibition in the antisaccade task. Journal of Experimental Psychology: General, 123, 374-393.
SAS Institute (1999). SAS/STAT User’s Guide, Version 8. Gary, NC: SAS Institute Inc.
Satterfield,J. H., & Schell, A. (1997). A prospective study of hyperactive boys with conduct problems and normal boys: adolescent and adult criminality. Journal of American Academy of Child and Adolescent Psychiatry, 36, 1726-1735.
Schoechlin, C., & Engel, R. R. (2005). Neuropsychological performance in adult attention-deficit hyperactivity disorder: Meta-analysis of empirical data. Archives of Clinical Neuropsychology, 20, 727-744.
Siegel, L. S. & Linder, A. (1984). Short-term memory processes in children with reading and arithmetic disabilities. Developmental Psychology, 20, 200-207.
Siegel, L. S., & Ryan, E. B. (1989). The development of working memory in normally achieving and subtypes of learning disabled children. Child Development, 60, 973-980.
Stevens, J., Quittner, A. L., Zuckerman, J. B., & Moore, S. (2002). Behavioral inhibition, self- regulation of motivation, and working memory in children with attention deficit hyperactivity disorder. Developmental Neuropsychology, 21, 117-140.
Sullivan, M. A., & Rudnik-Levin, F. (2001). Attention deficit/hyperactivity disorder and substance abuse. In J. Wasserstein, L. E. Wolf, & F. F. Lefever (Eds.), Adult attention deficit disorder: Brain mechanisms and life outcomes (pp.251-270). New York, NY: New York Academy of Sciences.
Swanson, H. L. (1993). Working memory in learning disability subgroups. Journal of Experimental Child Psychology, 56, 87-114.
Swanson, H. L. (1994). Short-term memory and working memory: Do both contribute to our understanding of academic achievement in children and adults with learning disabilities. Journal of Learning Disabilities, 27, 34-50.
Tunmer, W. E., & Hoover, W. A. (1992). Cognitive and linguistic factors in learning to read. In P. B. Gough, L. C. Ehri, & R. Treiman (Eds.), Reading acquisition processes (pp.175-214). Hillsdale, NJ: Erlbaum.
Wagner, R. K., & Torgesen, J. K. (1987). The nature of phonological processing and its causal role in the acquisition of reading skills. Psychological Bulletin, 101, 192-212.
Walker, A. J., Shores, E. A., Trollor, J. N., Lee, T., & Sachdev, P. S. (2000). Neuropsychological functioning of adults with attention deficit hyperactivity disorder. Journal of Clinical and Experimental Neuropsychology, 22, 115-124.
Wasserstein, J., Wolf, L. E., & LeFever, F. F. (2001). Adult attention deficit disorder: Brain mechanisms and life outcomes. New York, NY: New York Academy of Sciences.
Wechsler, D. (1997a). WAIS-III administration and scoring manual. San Antonio, TX: Psychological Corporation.
Wechsler, D. (1997b). Wechsler Memory Scale - Third Edition. San Antonio, TX: Psychological Corporation.
Weiss, G., Hechtman, L., Milroy, T., & Perlman, T. (1985). Psychiatric status of hyperactives as adults: A controlled perspective 15-year follow-up of 63 hyperactive children. Journal of the American Academy of Child Psychiatry, 24, 211-220.
Welsh, M. C. (2002). Developmental and clinical variations in executive functions. In D. L. Molfese, & V. J. Molfese (Eds.), Developmental variations in learning: Applications to social, executive function, language, and reading skills (pp.139-185). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
Welsh, M. C., & Pennington, B. F. (1988). Assessing frontal lobe functioning in children: Views from developmental psychology. Developmental Neuropsychology, 4, 199-230.
Wender, P. H., Wolf, L. E., & Wasserstein, J. (2001). Adults with ADHD: An overview. In J. Wasserstein, L. Wolf, & F. F. LeFever (Eds.), Adult attention deficit disorder: Brain mechanisms and life outcomes (pp.1-16). New York, NY: New York Academy of Sciences.
Wilen,, T. (2006). Attention deficit hyperactivity disorder and substance abuse. American Journal of Psychiatry, 163, 2059-2063.
Willcutt, E. G., & Pennington, B. F. (2000). Comorbidity of reading disability and attention deficit/hyperactivity disorder: Differences by gender and subtype. Journal of Learning Disabilities, 33, 179-191.
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.
Willcutt, E. G., Pennington, B. F., Boada, R., Ogline, J. S., Tunick, R. A., Chhabilda, N. A., & Olson, R. K. (2001). A comparison of the cognitive deficits in reading disability and attention-deficit/hyperactivity disorder. Journal of Abnormal Psychology, 110, 157-172.
Willcutt, E. G., Pennington, B. F., Olson, R. K., Chhabildas, N., & Hulslander, J. (2005). Neuropsychological analyses of comorbidity between reading disability and attention deficit hyperactivity disorder: In search of the common deficit. Developmental Neuropsychology, 27, 35-78.
Woodcock, R. W., McGrew, K. S., & Mather, N. (2001). Woodcock-Johnson Ⅲ Tests of Achievement. Itasca, IL: Riverside Publishing.