Stopping and changing in adults with ADHD

Background. A lack of inhibitory control has been suggested to be the core deficit in children with attention deficit hyperactivity disorder (ADHD). This means that a primary deficit in behavioral inhibition mediates a cascade of secondary deficits in other executive functions, such as arousal regul...

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Bibliographic Details
Published in:Psychological medicine 2005-06, Vol.35 (6), p.807-816
Main Authors: BEKKER, E. M., OVERTOOM, C. C., KENEMANS, J. L., KOOIJ, J. J., DE NOORD, I., BUITELAAR, J. K., VERBATEN, M. N.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Adult and adolescent clinical studies
Adults
Attention Deficit Disorder with Hyperactivity - complications
Attention Deficit Disorder with Hyperactivity - diagnosis
Attention Deficit Disorder with Hyperactivity - psychology
Attention deficit hyperactivity disorder
Biological and medical sciences
Children & youth
Cognition Disorders - diagnosis
Cognition Disorders - etiology
Deficits
Diagnostic and Statistical Manual of Mental Disorders
Female
Humans
Hyperactivity
Inhibition
Inhibition (Psychology)
Male
Medical sciences
Middle Aged
Miscellaneous
Psychological tests
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Reaction Time
Severity of Illness Index
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Summary:Background. A lack of inhibitory control has been suggested to be the core deficit in children with attention deficit hyperactivity disorder (ADHD). This means that a primary deficit in behavioral inhibition mediates a cascade of secondary deficits in other executive functions, such as arousal regulation. Clinical observations have revealed that with increasing age symptoms of hyperactivity and impulsivity decline at a higher rate than those of inattention. This might imply that a deficit in attention rather than a lack of inhibitory control is the major feature in adult ADHD. Method. To study whether an attentional or inhibitory deficit predominates, the stop-signal task and the stop-change task were presented to 24 adults with ADHD combined subtype and 24 controls. Results. Relative to controls, the stop-signal reaction time (SSRT) was significantly more prolonged than the go-stimulus reaction time (RT) in patients with ADHD. This disproportionate elongation of the SSRT was comparable across tasks, even though the stop-change task exerted more complex (or at least different) demands on the inhibitory system than the stop-signal task. ADHD patients had a higher proportion of choice errors, possibly reflecting more premature responses. Specifically in the stop-change task, patients had more variable choice responses and made more inappropriate change responses, which may also reflect enhanced impulsivity. Conclusions. The results support a core deficit in behavioral inhibition in adults with ADHD. We further suggest that there is more evidence for a critical role of deficient inhibitory control in adults than in children with ADHD.
ISSN:0033-2917
1469-8978
DOI:10.1017/S0033291704003459