Journal of Child Psychology and Psychiatry 48:10 (2007), pp 1033–1041


Early concurrent and longitudinal symptoms of ADHD and ODD: relations to different types of inhibitory control and working memory
Karin C. Brocki,1 Lilianne Nyberg,1 Lisa B. Thorell,1,2 and Gunilla Bohlin1

Department of Psychology, Uppsala University, Uppsala, Sweden; 2Stockholm Brain Institute, Stockholm, Sweden

Background: The aim of the present study was to investigate how three different types of inhibitory control – interference control within task, interference control outside task, and prepotent response inhibition – and two types of working memory – verbal and spatial – would relate to early symptoms of attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), both concurrently and longitudinally. Methods: Seventy-two preschoolers, 1/3 who had been identified as being at risk for developing ADHD and/or ODD, completed neuropsychological tasks designed to measure inhibitory control and working memory. Behavioral symptoms were measured through parental and teacher ratings of the DSM-IV criteria for ADHD and ODD. Results: Our results suggest distinct types of inhibitory control as being good predictors of concurrent and longitudinal symptoms of ADHD, rather than ODD. However, no associations were obtained between working memory and ADHD or ODD symptoms either concurrently or longitudinally. Conclusions: This study emphasizes the need to isolate complex executive processes and break them down into components in order to properly understand the neuropsychological roots involved in ADHD and ODD. Keywords: ADHD, ODD, inhibitory control, interference control, prepotent response inhibition, working memory.

Executive control involves a complex collection of cognitive processes that are critical for the execution of goal directed behavior. Deficits in such executive processes appear to be one of the important components in the causal neuropsychology of attention deficit/hyperactivity disorder (ADHD; e.g., Castellanos, Sonuga-Barke, Milham, & Tannock, 2006; Wilcutt, Doyle, Nigg, Faraone, & Pennington, 2005). Albeit not as consistent, executive control deficits have also been found in oppositional defiant disorder (ODD) and conduct disorder (CD) (e.g., Oosterlaan, Logan, & Sergeant, 1998; Moffitt, 1993; Se ´ guin, Boulerice, Harden, Tremblay, & Phil, 1999), suggesting that impairment in executive control is not a unique marker for ADHD. Recently, there has been an increase in the number of preschool children receiving an ADHD diagnosis (Sonuga-Barke, Auerbach, Campbell, Daley, & Thompson, 2005), which has led to a lively debate about the nature and developmental significance of preschool ADHD. Consequently, the need for longitudinal studies to investigate pathways between potential risk factors and later manifestation of the disorder has been emphasized (e.g., Nigg, 2006). However, most previous studies have focused on school-aged children and have not included longitudinal data. The present study aimed to investigate if two primary executive control functions, inhibitory control and working memory in the preschool age, are concurrently and
Conflict of interest statement: No conflicts declared.

longitudinally related to preschool symptoms of ADHD and ODD in a sample including children at risk for developing ADHD and/or ODD. The contribution of different types of inhibitory control and working memory processes to concurrent and longitudinal ADHD and ODD symptoms was of particular interest. In reviewing the large number of existent definitions of inhibitory control, Nigg (2000) makes a distinction between executive and motivational inhibition, with the former – further subdivided into motor inhibition and interference control – being better supported as a correlate to ADHD. Barkley’s (1997) influential theory of deficient inhibition as central to ADHD acknowledges a similar distinction between inhibition of a prepotent motor response and interference control. According to Barkley (1997), it may be interference within the task, rather than interference in the form of distraction outside the task, that is important in relation to ADHD. Working memory can be defined as a system that is used for temporary storage and manipulation of information involved in many higher cognitive functions (Smith & Jonides, 1999). Current definitions of working memory are largely influenced by the theoretical framework by Baddeley (1992; Baddeley & Hitch, 1994), separating verbal and visuo-spatial short-term storage processes and the central executive, which operates on the contents of storage. The meta-analysis by Martinussen, Hayden, HoggJohnson, and Tannock (2005), evaluating evidence

Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA

and prepotent response inhibition – and two types of working memory – verbal and spatial measures – would relate to concurrent and 2-year longitudinal symptoms of ADHD and ODD in a preschool Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. Longitudinal gap M ¼ 2 years. whether the different types of inhibitory control and working memory would relate to ADHD and ODD. Speltz. Sonuga-Barke. 2 months.28. At Time 1 (Age: M ¼ 5 years.. whereas others report no associWa ation between working memory and preschool ADHD symptoms (e. However. 1/3 of the children were recruited from local Child Health Care Centers on the basis that the children had been identified by child psychologists as being at high risk for primarily developing diagnosable ADHD and/or ODD. Dalen.47). 2005). the tasks were administered during two sessions over a period of 1 to 2 weeks. DeKlyen. With regard to working memory. Barke et al. Further. but the few clinical and non-clinical studies available in the literature suggest that impaired executive control should primarily be considered an associate of ADHD rather than of ODD (e. Some studies do report deficits in working memory (e. Although some studies have reported working memory impairments in children with ODD and/or CD (Se ´ guin et al. and Rydell (2003) found for a normal sample that inhibition measured at age 5 predicted ratings of hyperactivity and inattention at age 81/2. 1999. . SD ¼ . Kalff et al. Method Participants and procedures A total of 72 children (60 boys and 12 girls) participated in this study. there are also studies which have come to the opposite conclusion (Oosterlaan... SD ¼ . DeWolfe.g.. by controlling for comorbidity in the analyses. In an attempt to avoid possible fatigue effects.1034 Karin C.. Each session lasted approximately one hour with a break halfway through. 2003. 2006). Berlin & Bohlin. Berlin & Bohlin. Thorell & ˚ hlstedt. investigated the extent to which preschool executive deficits are specific to subsequent ADHD. Martinussen et al. Berlin. & Bawden. & Sergeant. 2002. 2006). The sample was supplemented by a group of normal children chosen to be proportional to the risk sample in terms of boy to girl ratio as well as age. Sonuga-Barke. 2005. 2002. it was predicted that significant relations would be obtained between the inhibitory control measures and concurrent and 2-years-later ADHD and ODD symptoms. ODD and/or CD in the school-aged years (Castellanos et al. sample including children at risk for developing ADHD and/or ODD. irrespective of ODD. Thorell & Wa Longitudinally. Aim of study The aim of this study was to investigate how three different types of inhibitory control – interference control within task. little is known about the role of executive processes in the expression of these disorders in the preschool period. and Hughes (2002) showed that hard-to-manage preschoolers exhibiting symptoms of ADHD had poorer inhibitory control than the control group at age 7.. the children were tested individually at the Department of Psychology. Age: M ¼ 7 years. 2006. Overall. Compared to the evidence showing impaired inhibitory control and working memory in ADHD. The inconsistency in previous findings based on preschool children offered no base for predictions with regard to relations between working memory and ADHD and ODD symptoms. Reasons for attrition were that parents did not give consent to contact the teacher (n ¼ 1) and the teachers were not willing to fill out the questionnaire (n ¼ 3). SD ¼ . The tasks within each session were administered in a randomized order. Byrne. The 7 tasks being analyzed in the current paper were part of a larger battery designed to tap various executive functions. questionnaire data from the children’s parents and teachers were collected for 72 and 68 of the children. Brocki et al.g. Greenberg. but the authors conclude that further studies on the nature and specificity of impairments in ADHD are needed. findings are not as consistent. 2002). ODD and/or CD. 2002. Taylor. Uppsala University. Sweden. These children were randomly selected and recruited through the local birth register of Uppsala County. 1999). 1998). questionnaire data from children’s parents and teachers were collected for 66 and 65 children respectively. Information about parental educational status (on a 5-step scale) was collected as a measure of social background and will be taken into account in the analyses (see Preliminary analyses). & Fisher.g. interference control outside task. 5 months..69). respectively. independently of one another.g. Bohlin. Sonuga˚ hlstedt. Scheres. At Time 2 (approximately 2 years after Time 1 measurements. as yet. 1998). Further. Calderon. Reasons for attrition were that the family had moved out of the area (n ¼ 2) or that the family no longer wished to participate (n ¼ 4). At Time 1. Dalen. parents did not give consent to contact the teacher (n ¼ 1). No children in the study were receiving psychostimulant medication for ADHD at the time. Oosterlaan et al. 2002. 2005. formed an open question.. At the end of each session the children received a gift worth approximately $7. Sonuga-Barke et al. Brophy. 2003. 6 months. The most consistent evidence for executive control deficits in association with ADHD symptoms in the preschool years holds for impaired inhibitory control (e.. It was further predicted that inhibitory control would relate primarily to ADHD symptoms.. to our knowledge no longitudinal studies have. Mariani & Barkley. Further. In order to obtain a sample of children scoring across the full range of ADHD symptom severity. Daley. & Remington. suggests that impairments may be stronger for visuo-spatial working memory.. on verbal and visuo-spatial working memory in relation to ADHD. There is a scarcity of empirical studies investigating the relation between executive control and ODD in preschool. & Remington. 2002. 1997.

Number of correct responses on this task. This ˚ hlstedt version has also been used by Thorell & Wa (2006). in which conflict was provided through the demand to say the opposite to what is shown in the picture (i. and not to respond at all when the examiner taps with the palm. The task is a preschool version of the visuo-spatial working memory task used by Klingberg and colleagues in functional magnetic resonance imaging (fMRI) studies and studies of diagnosed ADHD children (Klingberg. p < . & Conway. Engle. It is a task where the child is instructed to knock on the table when the examiner taps on the table. Movements and vocalizations in response to distractions as well as spontaneous reactions are recorded throughout the 75-sec period. Information: r ¼ . Following Barkley’s (1997) notion of two types of interference control – interference inside vs. The total points across all trials were obtained for forward and backward span.93. 1998/2000 for test–retest based on American children). day–night and boy–girl. Brocki & Bohlin. Within-task interference with a verbal response was studied using a Stroop-like task which did not require reading skills. The score is the number of 5-sec intervals the child is able to stand still. a blue triangle.e. the children were instructed to press a key (‘go’) when a frequent stimulus (a blue figure) appeared on the screen. & Klingberg. A computerized go/ no-go task was used to test the child’s ability to inhibit a prepotent response. the child is to tap with the side of the fist when the examiner knocks with the knuckles and vice versa. Spatial working memory. 3rd version (WISC-III. tested two weeks apart. with backward span presumably representing a higher level of difficulty (cf. dropping a pencil on the table. . Verbal working memory. and Wa Intelligence. using 30 children aged 4–5 years. with 48 being the maximum number. with closed eyes.84. dog.e. r ¼ . see Berlin & Bohlin. 2006. The score derived from the task was number of commission errors (pressing the key when a ‘no-go’ target was presented).Preschool ADHD and ODD symptoms: inhibition and working memory 1035 Measures Time 1 measurements Interference control. 1999). 2004). flower. with 2 trials at each span length. Split-half reliability for the Knock and Tap subtest based on Swedish children is . Based on the scores from 24 children between the ages of 4 and 5 years tested two weeks apart. 1998/2000) was used to assess within-task interference control of a motor response. and keep silent (maximum 15 points). tested about 2 months apart. This task was originally used with one picture pair (day–night) by Gerstadt.88 (Korkman et al.. 2002.1 IQ was measured using the Block Design and the Information subtests from the WISC-III (Wechsler. 1992/1994). we included both kinds of measures.69. 2 picture pairs were used (i. and to tap on the table when the examiner knocks on the table.67.. The children were informed that pigs would look out of the windows and the goal of the task was to try to remember their location.001. Each pig was displayed for 1000 ms and the time between each stimulus was 750 ms. These subtests have been shown to correlate highly with the full scale IQ (Block Design: r ¼ .68. to say night when the day picture is shown on the screen). and Diamond (1994). and the test is terminated when the child has failed both trials at any given span length. who report adequate test–retest reliability for this version (r ¼ . 1998/2000) was used to assess interference control in the form of resistance to distractions outside the task. This task is a modified version of the Digit span subtest of the Wechsler Intelligence Scale for Children. One point was awarded for each correctly identified location and the total number of points was used as a measure of spatial working memory.95... The same stimuli were used for the second part of the task. Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. and to inhibit their response every time they saw a triangle. chair) rather than digits to the child. In this study. depicting a pig sty containing 16 windows. r ¼ . Hirvikoski. The Knock and Tap subtest from the Developmental Neuropsychological Assessment Battery (NEPSY. Both measures were used to indicate verbal working memory. Forssberg. Reliability data for the Statue subtest is not available for Swedish children (see Korkman et al. Tuholski. p < . An aggregated measure of standard scores (i. with a ‘go-rate’ of 77%.0001).. In this computerized task. SD ¼ . outside of the task – as being of different importance for the expression of ADHD symptoms. adequate test– retest reliability for Word span was reported by Thorell ˚ hlstedt (2006).g.e. Hong. the test starts with a span length of 2. Korkman. Laughlin. The children were given two trials at each span length.g. but to make no response (‘no-go’) when an infrequent stimulus (a red figure) appeared. while the examiner tries to provoke reactions by producing sounds (e. During the first part of the task. or coughing). Altogether the task included 60 stimuli.. knocking on the table. Thus.001. The child is then asked to repeat every block of words in exactly the same. The score is the total number of correct responses (maximum 30 points). 4 months. Westerberg. and involves the experimenter reading series of unrelated nouns (e. 2006 for more information). who report adequate Thorell and Wa test–retest reliability. prepotency within the task was provided by the majority of the stimuli being ‘go-targets’ (see Berlin & Bohlin.. M ¼ 6 years. In a second task. 2002. with his or her eyes closed. 2004. irrespective of color. The Statue subtest from the NEPSY battery (Korkman et al. order in which it was read (Word span forward and backward). N ¼ 67). Groth-Marnat. Kemp. The child is to maintain a body position and remain silent. Wechsler. for more information). or the opposite. on a sample of twentytwo 4–5-year-olds. This task consisted of a blue square. It assesses the capacity to sustain a position and to inhibit motor responses to distractors. but the children were then instructed to press a key every time they saw a square. was used as a measure of interference control within task. children were shown a matrix on the screen. 1997). a red square. 1998/2000). and a red triangle presented one at a time on a computer screen.. respectively. Like the Digit span subtest. 1992/1994). & Kirk. This task has previously been used by ˚ hlstedt (2006). during a 75-sec period. p < . Prepotent response inhibition. the raw scores corrected for the child’s chronological 1 The intelligence tasks analyzed in this study were measured 12 to 18 months after Time 1 measurements (Age.

WM ¼ working memory. IQ Constructs Measures Interference within task 1. p < .08 ). 3. 1994).03 .09 ). .g.05). 1998). p < .01 ).00 . Internal consistency as measured by Cronbach’s alpha was high with regard to parent and teacher ratings of ADHD as well as ODD. Word Span Forward 7.01 respectively.001 and r ¼ .0001. and parent ratings of ODD at Time 1 (r ¼ ).19 – age) on the Block Design and the Information subtests was used as measure of intelligence. Further.20 . and 3 items are composed to assess impulsivity. therefore all results are presented adjusting for age. with coefficients ranging from .17 ). Strooplike task 1.22 . Anastopoulos.2 all analyses are also adjusted for social background. Brocki et al. As some of the performance variables and Correlations between social background and ADHD at Time 1 (r ¼ ).14 – .. ADHD and ODD symptoms were significantly correlated at both Time 1 and Time 2 (r ¼ .33.e. The two ADHD symptoms domains (i.84).61*** – .33** . Correlations between parent and teacher ratings for ADHD and ODD at Time 1 were r ¼ . and go/no-go commissions (r ¼ ).67.22 . hyperactivity/ impulsivity and inattention) were highly correlated at both Time 1 and Time 2 (r ¼ . working memory and IQ.0l.08 – . Note. DuPaul. p < . p < .21 ).22 .31. Knock and Tap 2. 6.90*** . due to significant correlations between social background and several of the behavioral and neuropsychological variables. Each item on the ADHD and ODD scales was scored on a 4-point scale ranging from 0 (never/seldom occurring) to 3 (very frequently occurring). Further. N ¼ 66–72 Results Preliminary analyses The analyses throughout this study are based on raw scores. At both Time 1 and Time 2.11 .001 and r ¼ . The questions in the ADHD and ODD scales were phrased to represent the child’s current behavior.97.31** .33. Interference within Taska 3. p ¼ . Table 1 shows the inter-correlations between the measures of inhibitory control. 9.01). This measure has been well validated and is frequently used within ADHD research (e.06 – . parents and teachers completed a questionnaire containing items from the DSM-IV criteria for ADHD (APA.69 to .18 . because of the weak correlation between parent and teacher ratings for ODD at Time 1. Mean scores across parent and teacher ratings for ADHD at Time 1 as well as for ADHD and ODD at Time 2 were used in the analyses.04 ). p ¼ .32** . 5. 1994).05. – .30* . respectively. Nine items are composed to assess inattention. A moderate to strong positive correlation was obtained between the Stroop-like task and the Knock and Tap task. 7.18 ). 2 Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. & Reid.31** .35** . **p < . However.01) and Word span forward (r ¼ . and the aggregated score is used to indicate interference control within task.89. aStandardized and aggregated measure of Stroop-like and Knock and Tap tasks. Word Span Backward 8. The questionnaire further contained 8 items from the DSM-IV criteria for oppositional defiant disorder (APA.00l Interference outside task Ratings of ADHD and ODD symptoms.75). Therefore.90*** – . 23. 2.87 to . *p < .22 . N ¼ 61–66 for analyses with IQ. these particular scales were analyzed separately.23.87. Adjusting for Age and Social Background. ***p < . 9. the Inhibition Measures and the Working Memory Measures. Statue 4. p < .15 ). Pig sty Table 1 Inter-correlations between IQ. and for Time 2 r ¼ . The ADHD and ODD rating measures represent averages across items.15 ).32** – ). Six items are composed to measure hyperactivity.31** – . Power.13 ). Verbal WM Time 1 and 2 measurements Spatial WM Prepotent response inhibition 6. Go/No-Go comissions 5.35** ..1036 Karin C.76 to . 8.06). 4.12 . these two measures were standardized and averaged. p < .

29**(.39**(.10) ). 0 H).19 M 66 91 10.00) ).58 0.11 to 2.64 2.47 1037 SD . These relations remained significant when controlling for teacher ratings of ODD symptoms (prepotent response inhibition. 3 Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.07. all results presented below are based on raw scores.42 3.21 17. ADHD symptoms). No significant correlations were obtained between parent ratings of ODD at T1 and any of the inhibitory control or working memory measures. N ¼ 66–72 Variable Age (months) Time 1 Age (months) Time 2 IQ Inhibition Interference control within task (Stroop-like Task + Knock and Tap) Interference control outside task (Statue) Prepotent response inhibition (Go/no-go commissions) Working Memory Spatial working memory (Pig sty) Verbal working memory (Word span forward) Verbal working memory (Word span backward) Behavioural Ratings ADHD T1 ODD T1 (parent ratings) ODD T1 (teacher ratings) ADHD T2 ODD T2 Minimum 49 84 4 )2.39***().15) ). these relations no longer remained significant. N ¼ attrition for: Stroop-like task (4 R.7 4.02 30 15 48 8 5 2.41***().84 2.13().30**(.03 2.89 4.13) ).e. For ease of interpretation.39 0.bp ¼ .10(. or children at risk ¼ R.44 0.71 0.62 0. and prepotent response inhibition correlated significantly to symptoms of ADHD at Time 1. logarithmic transformations were conducted.45***) . Knock and Tap (2 R.08(). respectively.06) ).Preschool ADHD and ODD symptoms: inhibition and working memory Table 2 Descriptive Statistics for Age.. Statue (2 R. 1 H). and symptoms of ADHD and ODD Table 2 shows descriptive statistics for executive measures.10) .98 14 0 0 2 0 0 0 0 0 0 Maximum 84 107 17 1.12). Analyses with these more adequately distributed variables did not change the level of significance in any of the analyses.53***(). and Behavioral Ratings.13().00) ). Interference control within task.15().04 to )1. but when partialing out the effect of teacher ratings of ADHD.36***(.34***(.92 0. .10) ).21(. respectively. The results showed a very similar pattern of findings for the two symptom domains.01(. Adjusted for Age and Social Background. Attrition for specific measures varied between one and five children.3 Concurrent relations between inhibition. Figures Within Parentheses Represent the Relations Adjusted for Comorbid ODD and ADHD Symptoms. Word span forward (1 R.69 .39 1.12) ).01 27. IQ.38 2.46***) . no significant correlations were obtained between parent ratings of ODD at Time 1 and any of Specification of attrition for each task and whether attrition was for healthy ¼ H.11(.09) ). are presented in Table 3. 0 H). working memory. all analyses were performed with ADHD symptoms divided into hyperactivity/ impulsivity and inattention. Further. 0 H). Go/no-go (0).93 ).17) ). kurtosis from ).27*) ). Pig sty (1 R. Respectively N ¼ 62–72 ADHD Symptoms T1 ODD Symptoms T1a ADHD Symptoms T2 ODD Symptoms T2 Inhibition Interference control within task Interference control outside task Prepotent response inhibition Working Memory Spatial working memory Verbal working memory (Word span forward) Verbal working memory (Word span backward) ).01.48***().45***().22) .75 2.67 0.35***(.12(). adjusted for age and social background. Finally.63.001 ratings of ADHD and ODD symptoms were skewed (skewness ranging from ). p ¼ .27*) ).03(. ***p < . The inhibitory measures also correlated significantly with teacher ratings of ODD symptoms at Time 1.07). and symptoms of ADHD and ODD for the total sample.51 Table 3 Concurrent and Longitudinal Relations from Inhibition and Working Memory Measures to ADHD and ODD Symptoms.68 0.61 0.00) ). Executive Measures.70 0.05) ). therefore all analyses below are presented based on the mean score across hyperactivity/impulsivity and inattention (i. interference control outside task. Word span backward (3 R. 2 H).03().00) ).09(). *p < . IQ.69 10. The concurrent and longitudinal relations from inhibition and working memory measures to ADHD and ODD symptoms.47 2.10) ). **p < .81 0. 0 H).20 1.09) .02) a ODD ratings at T1 denote teacher ratings only. Figures within parentheses in Table 3 represent the relations adjusted for comorbid ODD and ADHD symptoms.05.41***) ).08(.70 2. due to some children failing to complete a specific task.23b) ).

ß ¼ .09) and the explained variance was reduced to 19%. the inhibitory control measures.34. F (5. with the inhibition measures as predictor variables and the ADHD symptom score as the outcome variable.resp. were set to zero. p ¼ . p < .0001. No significant correlations between the two types of working memory and symptoms of ADHD and ODD were obtained at Time 1. the Stroop-like task. ßInterfer.05. r ¼ ). interference control outside task.39. we made a difference variable (ADHDT2 – ADHDT1) where scores below zero.05. no significant relations were obtained between the working memory measures and symptoms of ADHD or ODD at Time 2. and symptoms of ADHD and ODD Similarly to the concurrent relations.90. IQ was also significantly correlated with parent ratings of ODD at Time 1. variations in working memory did not contribute to the explained Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. r ¼ ).e. Second.09). Together the three types of inhibitory control explained 11% of the variance in ODD symptoms at Time 2.inhib. this study investigated the influence of different types of inhibitory control and working memory processes on concurrent and 2-year longitudinal symptoms of ADHD and ODD in a sample of preschool children.05. composite across the Stroop-like task and Knock and Tap).01. ßPrepot. p < . Together. The regression model was significant. but not with teacher ratings of ODD at Time 1. Interference control within task and prepotent response inhibition also correlated significantly with ratings of ODD symptoms at Time 2.03 to . 56) ¼ 2. These correlations remained significant when controlling for ODD symptoms. p < . First. With regard to correlations among IQ and the inhibitory control and working memory measures (presented in Table 1). (ßInterfer. the three types of inhibitory control correlated significantly with ADHD symptoms at Time 2 (see Table 3). To investigate whether the three types of inhibitory control contributed with common or independent variance in explaining ADHD symptoms at Time 2. To investigate whether early neuropsychological function could predict increase in ADHD symptoms. interference control within task. these measures were simultaneously entered into a multiple linear regression analysis. interference control within task. p < .01. A similar multiple regression analysis was conducted with ODD symptoms at Time 2 as the outcome variable and the inhibitory control measures as predictor variables. Discussion Motivated by the mounting need to identify early neuropsychological risk factors in developmental syndromes.31.27. Statue) and verbal working memory (i. and prepotent response inhibition explained 34% of the variance in ADHD symptoms.01. Knock and Tap as well as with interference control within task (i.e.1038 Karin C. R2 ¼ . interference control outside task (i.Task ¼ )..05). Again. regardless of control for ADHD symptoms. and combined parent and teacher ratings of ODD symptoms at Time 2. but when partialing out the effect of ADHD symptoms. interference control outside task. prepotent response inhibition. The results showed that only prepotent response inhibition contributed uniquely to the prediction of an increase in ADHD symptoms over time. p < .26.Within. ¼ . with none of the inhibitory control measures making independent contributions and the explained variance in ODD symptoms being reduced to 1%. 0001. r ¼ ).28. 56) ¼ 7.Outside.26. significant correlations were obtained between IQ. A similar pattern of results was obtained when conducting the same multiple regression analysis with control for ADHD symptoms. Longitudinal relations between inhibition. Brocki et al. reflecting decreases in ADHD symptoms over time. . p > . Word span backwards).25. R2 ¼ . Conversely. these relations no longer remained significant. the two types of interference control still made independent contributions.e.44. working memory. When conducting the same multiple regression analysis with control for ODD symptoms. made independent contributions to concurrent and 2-year longitudinal symptoms of ADHD.. relations between measures of inhibitory control and ODD were eliminated upon adjusting for ADHD symptoms.. and prepotent response inhibition.01. a multiple regression analysis with these three variables as predictors and the variable reflecting increase in ADHD symptoms as outcome was performed. p < .Task ¼ ). F (5. Interference control. Pearson correlation analyses were performed between the neuropsychological measures and the change variable.09. and verbal working memory were found to be at least near-significant predictors of increase in ADHD symptoms (p ¼ . Controlling for IQ when predicting ADHD and ODD symptoms from measures of inhibitory control and working memory did not change the level of significance of contributing variables. The regression model was significant. Intelligence IQ was significantly related to combined parent and teacher ratings of ADHD symptoms at Time 1 and Time 2. Further. Overall. p < . the findings showed that three distinct inhibitory processes. although the effect of prepotent response inhibition was only marginally significant (p < .21. r ¼ ). p < . p < . with all three types of inhibitory control predicting ratings of ADHD at Time 2 independently of one another.32. with none of the inhibitory control measures contributing with independent variance. 05. r ¼ ).

Nigg. & Wearing. Doyle. by suggesting potentially distinct inhibitory pathways between risk and later-developing ADHD. 2001. suggested that inhibitory control is the ‘first’ impaired neuropsychological component in ADHD. Barkley (1997).. whereas the relation to ODD is caused by the large overlap between ADHD and ODD (e. These symptoms at the sub-clinical level can be related to neuropsychological deficits and need to be controlled for dimensionally by using ADHD and/or ODD symptoms as a covariate (e. Hinshaw. & Oosterlaan. Concurrent and 2-year longitudinal relations between inhibitory control and symptoms of ADHD and ODD Regarding the concurrent relations between inhibitory control and ADHD symptoms. be noted that some studies of school-aged children have concluded that inhibitory control is not specifically related to ADHD. 2002).. Thorell & Wa results extend findings on elementary school-aged children to preschool children. interference control outside task. 2005. which in turn ‘sets the stage’ for impairments in later-developing. in elaborating his hybrid model of ADHD. The fact that our results showed very similar patterns of associations between the neuropsychological measures and the two ADHD symptom domains should be commented on. Corroborating Barkley’s hypothesis about developmental change in ADHD are findings by Brocki and Bohlin (2006) demonstrating that poor inhibition was most clearly associated with ADHD symptoms for children in late preschool and early school age. similar findings have been reported in the very few previous studies of preschoolers that have controlled for comorbidity (Berlin & Bohlin. 2002. These inconsistencies could be a result of the different developmental levels of the samples studied (preschool vs. Relations between different types of inhibitory control and ADHD symptoms While our overall results give support to existing data suggesting a strong link between preschool ADHD symptoms and inhibitory control (SonugaBarke et al.g. 2002. 2002 for reviews). 2005). for example. Pickering. These results are in line with findings from the preschool study by Sonuga-Barke and colleagues (2002). see Oosterlaan et al. In line with this developmental reasoning. 2005). 1998). Chhabildas.. Indeed. working memory did not correlate with concurrent or longitudinal symptoms of either ADHD or ODD. Ambridge. In other words. & Pennington. 1998.g. Sergeant. These results may be taken to contrast with findings on schoolaged children suggesting that impaired executive control is most strongly associated with inattention symptoms (e. and prepotent response inhibition predicted independent parts of the variance in ADHD symptoms two years later.. however.. this study takes the role of inhibitory control as a potential neuropsychological marker for ADHD a step further.g. Waschbusch. Together. 2002... ˚ hlstedt. however. school age). Carte. 2005. it could be speculated that the relative importance of different types of inhibitory control in relation to ADHD differs as a function of age. They showed reciprocal associations between the two ADHD symptom domains and executive deficits in the late preschool and early school-age years. The apparent contrast may. Berlin & Bohlin. 2004). Concurrent and 2-year longitudinal relations between working memory and behavioral problem symptoms In contrast to inhibitory control. whereas executive dysfunction was related only to inattention in older school-aged children. Martinussen & Tannock. Geurtz. Faraone. & Willcutt. It should. such as working memory and planning. 2006. Leung and Connolly (1996) that it is interference within task rather than interference outside the task that seems most important in relation to ADHD.. Sonuga-Barke et al. Thus. . Pennington. & Treuting. Nigg. the results showed that interference control within task. Oosterlaan et al. whereas poor functioning with regard to laterdeveloping and more complex executive functions such as working memory was associated only with inattention symptoms for older school aged children. the question of independent contributions of different types of inhibitory control to the explained variance Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. 2006). more complex executive functions.. This inconsistency in findings could be a result of having only studied group differences. This is an issue that awaits empirical testing and should be of interest in future studies examining ADHD from a developmental perspective. Willcutt. not taking into consideration that children with ODD often have elevated levels of ADHD symptoms. be understood by referring to the results reported by Brocki and Bohlin (2006). Martinussen et al..Preschool ADHD and ODD symptoms: inhibition and working memory 1039 variance of ADHD or ODD symptoms in this age period. but is also a neuropsychological correlate of ODD and CD (e.. given the fact that working memory processes are not sufficiently developed at preschool age (Gathercole. Although the current study does not specifically address neuropsychological correlates of ADHD as a function of age. 2002). in terms of inhibitory control being primarily related to ADHD.g. of ADHD has not been addressed in previous studies. a developmental explanation for this inconsistency seems plausible.g. These results contrast with Barkley’s (1997) proposition and the previous empirical findings of. these 2003. whereas most studies of older children have found associations between working memory and ADHD symptoms (e. Willcutt et al.

Characterizing cognition in ADHD: Beyond executive dysfunction. E. using verbal and spatial short-term memory as well as working memory measures. DC: Author.. 19–40. Child Neuropsychology. This result suggests several distinct inhibitory processes being associated with early ADHD symptoms.D. Brophy. Pennington. K. 15. Castellanos. Response inhibition. Thus. C. DeWolfe. (2001). 571–593. However. Milham. & Conway. 29. & Rydell...e. (1997). ADHD and the nature of selfcontrol. However. Uppsala University. Neuropsychology. Sonuga-Barke ˚ hlstedt. (1998). Fax: +46 18 471 21 23.J.E. executive functioning. A. (1994). and ADHD-symptoms: A longitudinal study from age 5 to 81/2. Washington. E. Engle. & Bohlin. it was only prepotent motor inhibition that predicted this change in ADHD symptoms independently of the other measures.. Berlin. 1997. Child Neuropsychology. and prepotent response inhibition.A. Working memory. Laughlin. 529–540.P.O. Science. 255–265. 242–251.R. R. Email: Karin.. additional research examining the link between working memory function.N..D. 485–493. H.1040 Karin C. interference control within task. 2003. Baddeley. Byrne. N. R. norms. K.. This finding provides unique evidence that early dysfunction in this particular type of inhibitory control might be a strong neuropsychological predictor for later ADHD symptoms.W.J. M. hyperactivity and conduct problems among preschool children. The lack of relation between executive function and ODD in this study underscores the need for future studies to examine neuropsychological or other factors that may specifically be linked with ODD symptoms.X. (1998). Brocki.D. 26. G. A. this explanation is less relevant for the lack of relation between backward word span (commonly thought to be a working memory measure) and ADHD symptoms. This explanation especially relates to the spatial working memory measure primarily tapping into the storage component (i. & Bohlin.uu. J. Anastopoulos. interference control outside task. It is currently unclear both empirically and theoretically whether shortterm memory measures actually do capture working memory in young children (Engle. (2006). (2002). 10. 117–123. Brocki..G. 31. A-M. G. E.. early neuropsychological function did contribute to the prediction of an increase in ADHD symptoms over time... however. Thorell & Wa ancies in results for working memory and ADHD in preschool children are not easily explained. that some preschool studies do report relations between working memory and ADHD (Mariani & Barkley. particularly when viewing ADHD as a Ó 2007 The Authors Journal compilation Ó 2007 Association for Child and Adolescent Mental Health. 1999). G. Developments in the concept of working memory. Tuholski. Together. M. Summary and conclusions To sum up. A. Trends in Cognitive Science. 255.. G. but may be attributable to variations in samples and type of measures used. A.. Working memory. A comparison of the neuropsychological profiles of the DSM-IV subtypes of ADHD. Executive functions in children age 6–13: A dimensional and developmental study. 556–559.. Brocki et al. & Conway. Sweden. (1999). the current findings stress the importance of studying how different types of inhibitory control are linked to ADHD symptom domains at different developmental stages. 4. Tuholski. & Bohlin. (1992). New York: Guilford Press. Further. Brocki. our results are supportive of the idea that inhibitory control is an important component of the early neuropsychology of ADHD rather than ODD.. (2003). Laughlin.F. & Tannock. Relations between inhibition. Acknowledgement This study was supported by a grant from The Bank of Sweden Tercentenary Foundation. & Willcutt. no relations to ADHD or ODD symptoms were obtained. L. J. S.W. Developmental change in the relation between executive functions and symptoms of ADHD and co-occurring behavior problems. & Bawden.. Power. Tel: +46 18 471 22 24. R. 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