Beyond the dual pathway model: evidence for the dissociation of timing, inhibitory, and delay-related impairments in attention-deficit/hyperactivity disorder

J Am Acad Child Adolesc Psychiatry. 2010 Apr;49(4):345-55. doi: 10.1016/j.jaac.2009.12.018.

Abstract

Objective: The dual pathway model explains neuro-psychological heterogeneity in Attention Deficit/Hyperactivity Disorder (ADHD) in terms of dissociable cognitive and motivational deficits each affecting some but not other patients. We explore whether deficits in temporal processing might constitute a third dissociable neuropsychological component of ADHD.

Method: Nine tasks designed to tap three domains (inhibitory control, delay aversion and temporal processing) were administered to ADHD probands (n=71; ages 6 to 17 years), their siblings (n=71; 65 unaffected by ADHD) and a group of non-ADHD controls (n=50). IQ and working memory were measured.

Results: Temporal processing, inhibitory control and delay-related deficits represented independent neuropsychological components. ADHD children differed from controls on all factors. For ADHD patients, the co-occurrence of inhibitory, temporal processing and delay-related deficits was no greater than expected by chance with substantial groups of patients showing only one problem. Domain-specific patterns of familial co-segregation provided evidence for the validity of neuropsychological subgroupings.

Conclusion: The current results illustrate the neuropsychological heterogeneity in ADHD and initial support for a triple pathway model. The findings need to be replicated in larger samples.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attention Deficit Disorder with Hyperactivity* / physiopathology
  • Attention Deficit Disorder with Hyperactivity* / psychology
  • Child
  • Cognition*
  • Humans
  • Inhibition, Psychological*
  • Intelligence Tests
  • Memory, Short-Term
  • Models, Neurological
  • Models, Psychological
  • Motivation*
  • Neuropsychological Tests
  • Neuropsychology*
  • Siblings
  • Time Perception