Neuropsychological Profile of Executive Function in Girls with Attention-Deficit/Hyperactivity Disorder

Abstract

The majority of research on neurobehavioral functioning among children with Attention-Deficit/Hyperactivity Disorder (ADHD) is based on samples comprised primarily (or exclusively) of boys. Although functional impairment is well established, available research has yet to specify a neuropsychological profile distinct to girls with ADHD. The purpose of this study was to examine performance within four components of executive function (EF) in contemporaneously recruited samples of girls and boys with ADHD. Fifty-six children with ADHD (26 girls) and 90 controls (42 girls), ages 8-13, were administered neuropsychological tests emphasizing response inhibition, response preparation, working memory, and planning/shifting. There were no significant differences in age or SES between boys or girls with ADHD or their sex-matched controls; ADHD subtype distribution did not differ by sex. Compared with controls, children with ADHD showed significant deficits on all four EF components. Girls and boys with ADHD showed similar patterns of deficit on tasks involving response preparation and working memory; however, they manifested different patterns of executive dysfunction on tasks related to response inhibition and planning. Girls with ADHD showed elevated motor overflow, while boys with ADHD showed greater impairment during conscious, effortful response inhibition. Girls, but not boys with ADHD, showed impairment in planning. There were no differences between ADHD subtypes on any EF component. These findings highlight the importance of studying boys and girls separately (as well as together) when considering manifestations of executive dysfunction in ADHD.

Planning Skills of Adolescents With ADHD

“…On parent-rated questionnaires, children (Gioia et al, 2002;Shimoni et al, 2012;Siu & Zhou, 2014) as well as adolescents with ADHD (this study; Toplak et al, 2009) consistently show more planning problems than controls. With regard to neurocognitive tasks of planning skills, a discrepancy is visible: On "paper-andpencil," tasks results are mixed in both child and adolescent samples (this study; Galasso et al, 2014;Klorman et al, 1999;Nigg et al, 2002;O'Brien et al, 2010;Qian et al, 2013;Shimoni et al, 2012;Siu & Zhou, 2014;, whereas on computerized tasks, studies consistently show planning deficits in both children and adolescents with ADHD (Gau et al, 2009;Gau & Shang, 2010;Song & Hakoda, 2014;Toplak et al, 2009). In line with the literature, also in our study on parent-rated measures, planning deficits were found, and in our paper-and-pencil neuropsychological measures, we found a significant deficit on one task (BADS) but not on another (D-KEFS).…”

Physical Exercise Alleviates ADHD Symptoms: Regional Deficits and Development Trajectory

“…Gender differences account for differential expression of ADHD: girls with ADHD commonly display elevated motor overflow and lack of planning, whereas boys with ADHD display greater impairment during conscious, effortful response inhibition (O'Brien et al 2010). This sex-related splaying of symptom expression complicates the issue.…”

The Role of Neuropsychological Assessment in the Functional Outcomes of Children with ADHD

“…are not unique to ADHD, and are common among other emotional and behavioral disorders (e.g., learning disorders, anxiety, depression; American Psychiatric Association 2000), as well as among treatable medical conditions (e.g., thyroid dysfunction, eczema, hearing loss; Feagans et al 1994;Hauser et al 1993;Kooistra et al 1996;Schmitt et al 2009). Moreover, diagnosis of ADHD in girls is even more complicated than it is in boys, due to later age of onset, more subtle clinical manifestations, and limitations associated with the DSM-IV diagnostic nomenclature (Taylor and Keltner 2002;O'Brien et al 2010). Although ADHD presents considerable challenges on its own, diagnosis and treatment is often significantly complicated by cooccurring emotional disorders.…”