Journal of Child Psychology and Psychiatry 48:10 (2007), pp 1033–1041 doi:10.1111/j.1469-7610.2007.01811.

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
1
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 concur-
rently 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 longitudinally related to preschool symptoms 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 com-
ponents in the causal neuropsychology of attention
deficit/hyperactivity disorder (ADHD; e.g., Castell-
anos, 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; Séguin,
Boulerice, Harden, Tremblay, & Phil, 1999), sug-
gesting 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, Auer-
bach, 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 previ-
ous 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.
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
ADHD and ODD in a sample including children at
risk for developing ADHD and/or ODD. The contri-
bution 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 defini-
tions of inhibitory control, Nigg (2000) makes a dis-
tinction 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 func-
tions (Smith & Jonides, 1999). Current definitions of
working memory are largely influenced by the theo-
retical framework by Baddeley (1992; Baddeley &
Hitch, 1994), separating verbal and visuo-spatial
short-term storage processes and the central exec-
utive, which operates on the contents of storage. The
meta-analysis by Martinussen, Hayden, Hogg-
Johnson, and Tannock (2005), evaluating evidence
1034 Karin C. Brocki et al.
on verbal and visuo-spatial working memory in
relation to ADHD, suggests that impairments may be
stronger for visuo-spatial working memory, but the
authors conclude that further studies on the nature
and specificity of impairments in ADHD are needed.
Although some studies have reported working
memory impairments in children with ODD and/or
CD (Séguin et al., 1999), there are also studies which
have come to the opposite conclusion (Oosterlaan,
Scheres, & Sergeant, 2005).
Compared to the evidence showing impaired
inhibitory control and working memory in ADHD,
ODD and/or CD in the school-aged years
(Castellanos et al., 2006; Martinussen et al., 2005;
Oosterlaan et al., 2005, 1998), little is known about
the role of executive processes in the expression of
these disorders in the preschool period. The most
consistent evidence for executive control deficits in
association with ADHD symptoms in the preschool
years holds for impaired inhibitory control (e.g.,
Berlin & Bohlin, 2002; Sonuga-Barke, Dalen, Daley,
& Remington, 2002; Byrne, DeWolfe, & Bawden,
1998). With regard to working memory, findings are
not as consistent. Some studies do report deficits in
working memory (e.g., Mariani & Barkley, 1997;
Sonuga-Barke, Dalen, & Remington, 2003; Thorell &
Wåhlstedt, 2006), whereas others report no associ-
ation between working memory and preschool ADHD
symptoms (e.g., Sonuga-Barke et al., 2002). There is
a scarcity of empirical studies investigating the
relation between executive control and ODD in pre-
school, 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.g., Kalff
et al., 2002; Speltz, DeKlyen, Calderon, Greenberg,
& Fisher, 1999; Berlin & Bohlin, 2002; Sonuga-
Barke et al., 2002, 2003; Thorell & Wåhlstedt, 2006).
Longitudinally, Berlin, Bohlin, and Rydell (2003)
found for a normal sample that inhibition measured
at age 5 predicted ratings of hyperactivity and inat-
tention at age 81/2. Further, Brophy, Taylor, and
Hughes (2002) showed that hard-to-manage pre-
schoolers exhibiting symptoms of ADHD had poorer
inhibitory control than the control group at age 7.
However, to our knowledge no longitudinal studies
have, as yet, investigated the extent to which
preschool executive deficits are specific to sub-
sequent ADHD, ODD and/or CD, by controlling for
comorbidity in the analyses.
Aim of study
The aim of this 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 meas-
ures – would relate to concurrent and 2-year longi-
tudinal symptoms of ADHD and ODD in a preschool
Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.
sample including children at risk for developing
ADHD and/or ODD. Overall, it was predicted that
significant relations would be obtained between the
inhibitory control measures and concurrent and
2-years-later ADHD and ODD symptoms. It was
further predicted that inhibitory control would relate
primarily to ADHD symptoms, irrespective of ODD.
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. Further, whether
the different types of inhibitory control and working
memory would relate to ADHD and ODD, indepen-
dently of one another, formed an open question.
Method
Participants and procedures
A total of 72 children (60 boys and 12 girls) participated
in this study. In order to obtain a sample of children
scoring across the full range of ADHD symptom sever-
ity, 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. 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. These
children were randomly selected and recruited through
the local birth register of Uppsala County, Sweden. No
children in the study were receiving psychostimulant
medication for ADHD at the time.
At Time 1 (Age: M ¼ 5 years, 5 months; SD ¼ .69),
the children were tested individually at the Department
of Psychology, Uppsala University. The 7 tasks being
analyzed in the current paper were part of a larger
battery designed to tap various executive functions. In
an attempt to avoid possible fatigue effects, the tasks
were administered during two sessions over a period of
1 to 2 weeks. The tasks within each session were
administered in a randomized order. Each session las-
ted approximately one hour with a break halfway
through. At the end of each session the children
received a gift worth approximately $7. At Time 1,
questionnaire data from the children’s parents and
teachers were collected for 72 and 68 of the children,
respectively. 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). At Time 2 (approximately 2 years after Time 1
measurements; Longitudinal gap M ¼ 2 years,
2 months; SD ¼ .28; Age: M ¼ 7 years, 6 months;
SD ¼ .47), questionnaire data from children’s parents
and teachers were collected for 66 and 65 children
respectively. 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). Further, parents
did not give consent to contact the teacher (n ¼ 1).
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).
Ó 2007 The Authors
 Preschool ADHD and ODD symptoms: inhibition and working memory
Measures
Time 1 measurements
Interference control. Following Barkley’s (1997) notion of
two types of interference control – interference inside vs.
outside of the task – as being of different importance for
the expression of ADHD symptoms, we included both
kinds of measures. Within-task interference with a
verbal response was studied using a Stroop-like task
which did not require reading skills. This task was
originally used with one picture pair (day–night) by
Gerstadt, Hong, and Diamond (1994), in which conflict
was provided through the demand to say the opposite to
what is shown in the picture (i.e., to say night when the
day picture is shown on the screen). In this study, 2
picture pairs were used (i.e., day–night and boy–girl; see
Berlin & Bohlin, 2002; Brocki & Bohlin, 2004, 2006 for
more information). Number of correct responses on this
task, with 48 being the maximum number, was used as
a measure of interference control within task. This
version has also been used by Thorell & Wåhlstedt
(2006), who report adequate test–retest reliability for
this version (r ¼ .84, p < .0001), on a sample of twenty-
two 4–5-year-olds, tested two weeks apart.
The Knock and Tap subtest from the Developmental
Neuropsychological Assessment Battery (NEPSY;
Korkman, Kemp, & Kirk, 1998/2000) was used to
assess within-task interference control of a motor
response. It is a task where the child is instructed
to knock on the table when the examiner taps on the
table, and to tap on the table when the examiner knocks
on the table. In a second task, the child is to tap with
the side of the fist when the examiner knocks with the
knuckles and vice versa, and not to respond at all when
the examiner taps with the palm. The score is the total
number of correct responses (maximum 30 points).
Split-half reliability for the Knock and Tap subtest
based on Swedish children is .88 (Korkman et al.,
1998/2000).
The Statue subtest from the NEPSY battery (Korkman
et al., 1998/2000) was used to assess interference
control in the form of resistance to distractions outside
the task. It assesses the capacity to sustain a position
and to inhibit motor responses to distractors. The child
is to maintain a body position and remain silent, with
closed eyes, during a 75-sec period, while the examiner
tries to provoke reactions by producing sounds (e.g.,
dropping a pencil on the table, knocking on the table, or
coughing). Movements and vocalizations in response
to distractions as well as spontaneous reactions are
recorded throughout the 75-sec period. The score is the
number of 5-sec intervals the child is able to stand still,
with his or her eyes closed, and keep silent (maximum
15 points). Reliability data for the Statue subtest is not
available for Swedish children (see Korkman et al.,
1998/2000 for test–retest based on American children).
Prepotent response inhibition. A computerized go/
no-go task was used to test the child’s ability to inhibit a
prepotent response. This task consisted of a blue
square, a blue triangle, a red square, and a red triangle
presented one at a time on a computer screen. During
the first part of the task, the children were instructed to
press a key (‘go’) when a frequent stimulus (a blue
Ó 2007 The Authors
Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.
1035
figure) appeared on the screen, but to make no response
(‘no-go’) when an infrequent stimulus (a red figure)
appeared. The same stimuli were used for the second
part of the task, but the children were then instructed
to press a key every time they saw a square, and to
inhibit their response every time they saw a triangle,
irrespective of color. Altogether the task included 60
stimuli, with a ‘go-rate’ of 77%. Thus, prepotency within
the task was provided by the majority of the stimuli
being ‘go-targets’ (see Berlin & Bohlin, 2002, for more
information). The score derived from the task was
number of commission errors (pressing the key when a
‘no-go’ target was presented).
Spatial working memory. In this computerized task,
children were shown a matrix on the screen, depicting
a pig sty containing 16 windows. The children were
informed that pigs would look out of the windows and
the goal of the task was to try to remember their loca-
tion. Each pig was displayed for 1000 ms and the time
between each stimulus was 750 ms. The children were
given two trials at each span length. One point was
awarded for each correctly identified location and the
total number of points was used as a measure of spatial
working memory. This task has previously been used by
Thorell and Wåhlstedt (2006), who report adequate
test–retest reliability, r ¼ .69, p < .001, using 30
children aged 4–5 years, tested about 2 months apart.
The task is a preschool version of the visuo-spatial
working memory task used by Klingberg and colleagues
in functional magnetic resonance imaging (fMRI) stud-
ies and studies of diagnosed ADHD children (Klingberg,
2006; Westerberg, Hirvikoski, Forssberg, & Klingberg,
2004).
Verbal working memory. This task is a modified
version of the Digit span subtest of the Wechsler Intel-
ligence Scale for Children, 3rd version (WISC-III;
Wechsler, 1992/1994), and involves the experimenter
reading series of unrelated nouns (e.g., flower, dog,
chair) rather than digits to the child. The child is then
asked to repeat every block of words in exactly the
same, or the opposite, order in which it was read (Word
span forward and backward). Like the Digit span sub-
test, the test starts with a span length of 2, with 2 trials
at each span length, and the test is terminated when the
child has failed both trials at any given span length.
Both measures were used to indicate verbal working
memory, with backward span presumably representing
a higher level of difficulty (cf. Engle, Tuholski, Laughlin,
& Conway, 1999). The total points across all trials were
obtained for forward and backward span, respectively.
Based on the scores from 24 children between the ages
of 4 and 5 years tested two weeks apart, adequate test–
retest reliability for Word span was reported by Thorell
and Wåhlstedt (2006), r ¼ .67, p < .001.
Intelligence.1 IQ was measured using the Block
Design and the Information subtests from the WISC-III
(Wechsler, 1992/1994). These subtests have been
shown to correlate highly with the full scale IQ (Block
Design: r ¼ .93; Information: r ¼ .95; Groth-Marnat,
1997). An aggregated measure of standard scores (i.e.,
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; M ¼
6 years, 4 months; SD ¼ .68, N ¼ 67).
1036 Karin C. Brocki et al.

age) on the Block Design and the Information subtests

9. Word Span
Backward
was used as measure of intelligence.

.32**
.33**

.31**
.22

.13
).03
.12
.19
–
Time 1 and 2 measurements

Verbal WM
Ratings of ADHD and ODD symptoms. At both Time
1 and Time 2, parents and teachers completed a ques-

8. Word Span
tionnaire containing items from the DSM-IV criteria for

Forward

.22
.11
.18
.22
.18
).22
.06
ADHD (APA, 1994). This measure has been well vali-

–
dated and is frequently used within ADHD research

Table 1 Inter-correlations between IQ, the Inhibition Measures and the Working Memory Measures, Adjusting for Age and Social Background, N ¼ 66–72
(e.g., DuPaul, Power, Anastopoulos, & Reid, 1998). Nine
items are composed to assess inattention. Six items are
composed to measure hyperactivity, and 3 items are

Spatial WM
composed to assess impulsivity. The questionnaire

7. Pig sty

Note. N ¼ 61–66 for analyses with IQ, WM ¼ working memory. aStandardized and aggregated measure of Stroop-like and Knock and Tap tasks.
.21
).04
).01
).00
.09
).08
further contained 8 items from the DSM-IV criteria for

–
oppositional defiant disorder (APA, 1994). 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). The ADHD and ODD rating

Prepotent response inhibition

measures represent averages across items. Internal
consistency as measured by Cronbach’s alpha was high
with regard to parent and teacher ratings of ADHD as

6. Go/No-Go
comissions
well as ODD, with coefficients ranging from .87 to .97.

).15
).15
).08
).17
).14
The questions in the ADHD and ODD scales were

–
phrased to represent the child’s current behavior. The
two ADHD symptoms domains (i.e., hyperactivity/
impulsivity and inattention) were highly correlated at
both Time 1 and Time 2 (r ¼ .76 to .84). Further, ADHD
and ODD symptoms were significantly correlated at
both Time 1 and Time 2 (r ¼ .69 to .75). Correlations
between parent and teacher ratings for ADHD and ODD
Interference outside task

at Time 1 were r ¼ .87, p < .001 and r ¼ .33, p < .01

respectively, and for Time 2 r ¼ .89, p < .001 and r ¼
.67, p < .0001, respectively. Mean scores across parent
5. Statue

.35**

.31**
.32**
and teacher ratings for ADHD at Time 1 as well as for
.20

–
ADHD and ODD at Time 2 were used in the analyses.
However, because of the weak correlation between
parent and teacher ratings for ODD at Time 1, these
particular scales were analyzed separately.
4. Interference

Results
within Taska

.90***
.90***
.35**

Preliminary analyses
–
Interference within task

The analyses throughout this study are based on raw

scores, therefore all results are presented adjusting
for age. Further, due to significant correlations
3. Knock
and Tap

between social background and several of the

.61***

behavioral and neuropsychological variables,2 all

.30*

analyses are also adjusted for social background.

Table 1 shows the inter-correlations between the
measures of inhibitory control, working memory and
2. Stroop-
like task

.31**

IQ. A moderate to strong positive correlation was

–

obtained between the Stroop-like task and the Knock

*p < .05, **p < .0l, ***p < .00l

and Tap task. Therefore, these two measures were

standardized and averaged, and the aggregated
1. IQ

score is used to indicate interference control within

–

task. As some of the performance variables and

Constructs

2
Measures

Correlations between social background and ADHD at Time 1

(r ¼ ).31, p < .01), and parent ratings of ODD at Time 1 (r ¼
).23, p ¼ .06), and go/no-go commissions (r ¼ ).33, p < .01)
1.
2.
3.
4.
5.
6.
7.
8.
9.

and Word span forward (r ¼ . 23, p ¼ .05).

Ó 2007 The Authors

Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.
 Preschool ADHD and ODD symptoms: inhibition and working memory 1037

Table 2 Descriptive Statistics for Age, IQ, Executive Measures, and Behavioral Ratings, N ¼ 66–72

Variable Minimum Maximum M SD

Age (months) Time 1 49 84 66 .69

Age (months) Time 2 84 107 91 .47
IQ 4 17 10.93 2.67
Inhibition
Interference control within task (Stroop-like Task + Knock and Tap) )2.98 1.02 ).01 0.89
Interference control outside task (Statue) 14 30 27.42 4.03
Prepotent response inhibition (Go/no-go commissions) 0 15 3.21 2.69
Working Memory
Spatial working memory (Pig sty) 0 48 17.7 10.39
Verbal working memory (Word span forward) 2 8 4.84 1.20
Verbal working memory (Word span backward) 0 5 2.62 1.39
Behavioural Ratings
ADHD T1 0 2.70 0.92 0.70
ODD T1 (parent ratings) 0 2.75 0.68 0.58
ODD T1 (teacher ratings) 0 2.38 0.44 0.61
ADHD T2 0 2.64 0.81 0.71
ODD T2 0 2.19 0.47 0.51

Table 3 Concurrent and Longitudinal Relations from Inhibition and Working Memory Measures to ADHD and ODD Symptoms,
Adjusted for Age and Social Background. Figures Within Parentheses Represent the Relations Adjusted for Comorbid ODD and
ADHD Symptoms, Respectively N ¼ 62–72

ADHD Symptoms T1 ODD Symptoms T1a ADHD Symptoms T2 ODD Symptoms T2

Inhibition
Interference control within task ).41***().27*) ).39***().12) ).48***().41***) ).30**(.10)
Interference control outside task ).53***().46***) ).34***(.09) ).45***().45***) ).21(.22)
Prepotent response inhibition .36***(.23b) .35***(.10) .39**(.27*) .29**(.00)
Working Memory
Spatial working memory ).03().15) .10(.17) ).01(.09) ).09().13)
Verbal working memory (Word span forward) ).13().00) ).12().06) ).15().10) ).11(.00)
Verbal working memory (Word span backward) ).03(.00) ).08().05) ).13().10) ).08(.02)
a
ODD ratings at T1 denote teacher ratings only. No significant correlations were obtained between parent ratings of ODD at T1 and
any of the inhibitory control or working memory measures.bp ¼ .07.
*p < .05, **p < .01, ***p < .001

ratings of ADHD and ODD symptoms were skewed Concurrent relations between inhibition, working
(skewness ranging from ).04 to )1.63, kurtosis from memory, and symptoms of ADHD and ODD
).11 to 2.12), logarithmic transformations were
Table 2 shows descriptive statistics for executive
conducted. Analyses with these more adequately
measures, IQ, and symptoms of ADHD and ODD for
distributed variables did not change the level of
the total sample. The concurrent and longitudinal
significance in any of the analyses. For ease of
relations from inhibition and working memory meas-
interpretation, all results presented below are based
ures to ADHD and ODD symptoms, adjusted for age
on raw scores. Finally, all analyses were performed
and social background, are presented in Table 3.
with ADHD symptoms divided into hyperactivity/
Figures within parentheses in Table 3 represent the
impulsivity and inattention, respectively. The results
relations adjusted for comorbid ODD and ADHD
showed a very similar pattern of findings for the two
symptoms, respectively.
symptom domains, therefore all analyses below are
Interference control within task, interference con-
presented based on the mean score across hyper-
trol outside task, and prepotent response inhibition
activity/impulsivity and inattention (i.e., ADHD
correlated significantly to symptoms of ADHD at Time
symptoms). Attrition for specific measures varied
1. These relations remained significant when con-
between one and five children, due to some children
trolling for teacher ratings of ODD symptoms (pre-
failing to complete a specific task.3
potent response inhibition, p ¼ .07). The inhibitory
measures also correlated significantly with teacher
3
ratings of ODD symptoms at Time 1, but when
Specification of attrition for each task and whether attrition
was for healthy ¼ H, or children at risk ¼ R. N ¼ attrition for:
partialing out the effect of teacher ratings of ADHD,
Stroop-like task (4 R, 1 H); Knock and Tap (2 R, 0 H); Go/no-go these relations no longer remained significant.
(0); Statue (2 R, 2 H); Pig sty (1 R, 0 H); Word span forward (1 R, Further, no significant correlations were obtained
0 H); Word span backward (3 R, 0 H). between parent ratings of ODD at Time 1 and any of
Ó 2007 The Authors
Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.
1038 Karin C. Brocki et al.
the inhibitory control measures, regardless of control
for ADHD symptoms.
No significant correlations between the two types
of working memory and symptoms of ADHD and
ODD were obtained at Time 1.
Longitudinal relations between inhibition, working
memory, and symptoms of ADHD and ODD
Similarly to the concurrent relations, the three types
of inhibitory control correlated significantly with
ADHD symptoms at Time 2 (see Table 3). These
correlations remained significant when controlling
for ODD symptoms. Interference control within task
and prepotent response inhibition also correlated
significantly with ratings of ODD symptoms at Time
2, but when partialing out the effect of ADHD
symptoms, these relations no longer remained sig-
nificant. Again, no significant relations were ob-
tained between the working memory measures and
symptoms of ADHD or ODD at Time 2.
To investigate whether the three types of inhibitory
control contributed with common or independent
variance in explaining ADHD symptoms at Time 2,
these measures were simultaneously entered into a
multiple linear regression analysis, with the inhibi-
tion measures as predictor variables and the ADHD
symptom score as the outcome variable. The
regression model was significant, F (5, 56) ¼ 7.28,
p < . 0001, R2 ¼ .39, with all three types of inhibitory
control predicting ratings of ADHD at Time 2
independently of one another, (ßInterfer.Within.Task ¼
).34, p < .01, ßInterfer.Outside.Task ¼ ).27, p < .05,
ßPrepot.resp.inhib. ¼ .26, p < .05). Together, interfer-
ence control within task, interference control outside
task, and prepotent response inhibition explained
34% of the variance in ADHD symptoms. When
conducting the same multiple regression analysis
with control for ODD symptoms, the two types of
interference control still made independent contri-
butions, although the effect of prepotent response
inhibition was only marginally significant (p < .09)
and the explained variance was reduced to 19%.
A similar multiple regression analysis was con-
ducted with ODD symptoms at Time 2 as the outcome
variable and the inhibitory control measures as
predictor variables. The regression model was
significant, F (5, 56) ¼ 2.90, p < . 05, R2 ¼ .21, with
none of the inhibitory control measures contributing
with independent variance. Together the three types
of inhibitory control explained 11% of the variance
in ODD symptoms at Time 2. A similar pattern of
results was obtained when conducting the same
multiple regression analysis with control for ADHD
symptoms, with none of the inhibitory control meas-
ures making independent contributions and the
explained variance in ODD symptoms being reduced
to 1%.
To investigate whether early neuropsychological
function could predict increase in ADHD symptoms,
Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.
we made a difference variable (ADHDT2 – ADHDT1)
where scores below zero, reflecting decreases in
ADHD symptoms over time, were set to zero. First,
Pearson correlation analyses were performed
between the neuropsychological measures and the
change variable. Interference control, prepotent
response inhibition, and verbal working memory
were found to be at least near-significant predictors
of increase in ADHD symptoms (p ¼ .03 to .09).
Second, a multiple regression analysis with these
three variables as predictors and the variable
reflecting increase in ADHD symptoms as outcome
was performed. The results showed that only
prepotent response inhibition contributed uniquely
to the prediction of an increase in ADHD symptoms
over time, ß ¼ .25, p ¼ .05.
Intelligence
IQ was significantly related to combined parent and
teacher ratings of ADHD symptoms at Time 1 and
Time 2, r ¼ ).44, p < .0001, r ¼ ).32, p < .01. IQ
was also significantly correlated with parent ratings
of ODD at Time 1, r ¼ ).31, p < .01, and combined
parent and teacher ratings of ODD symptoms at
Time 2, r ¼ ).26, p < .01, but not with teacher rat-
ings of ODD at Time 1, r ¼ ).09, p > .05. With regard
to correlations among IQ and the inhibitory control
and working memory measures (presented in
Table 1), significant correlations were obtained
between IQ, the Stroop-like task, Knock and Tap as
well as with interference control within task (i.e.,
composite across the Stroop-like task and Knock
and Tap), interference control outside task (i.e.,
Statue) and verbal working memory (i.e., Word span
backwards). 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 vari-
ables.
Discussion
Motivated by the mounting need to identify early
neuropsychological risk factors in developmental
syndromes, this study investigated the influence of
different types of inhibitory control and working
memory processes on concurrent and 2-year lon-
gitudinal symptoms of ADHD and ODD in a sample
of preschool children. Overall, the findings showed
that three distinct inhibitory processes, interference
control within task, interference control outside
task, and prepotent response inhibition, made
independent contributions to concurrent and
2-year longitudinal symptoms of ADHD. Con-
versely, relations between measures of inhibitory
control and ODD were eliminated upon adjusting
for ADHD symptoms. Further, variations in work-
ing memory did not contribute to the explained
Ó 2007 The Authors
 Preschool ADHD and ODD symptoms: inhibition and working memory
variance of ADHD or ODD symptoms in this age
period.
Concurrent and 2-year longitudinal relations
between inhibitory control and symptoms
of ADHD and ODD
Regarding the concurrent relations between inhibit-
ory control and ADHD symptoms, similar findings
have been reported in the very few previous studies
of preschoolers that have controlled for comorbidity
(Berlin & Bohlin, 2002; Sonuga-Barke et al., 2002,
2003; Thorell & Wåhlstedt, 2006). Together, these
results extend findings on elementary school-aged
children to preschool children, in terms of inhibitory
control being primarily related to ADHD, whereas the
relation to ODD is caused by the large overlap be-
tween ADHD and ODD (e.g., see Oosterlaan et al.,
2005; Waschbusch, 2002 for reviews). It should,
however, be noted that some studies of school-aged
children have concluded that inhibitory control is
not specifically related to ADHD, but is also a neuro-
psychological correlate of ODD and CD (e.g., Oos-
terlaan et al., 1998; Sergeant, Geurtz, & Oosterlaan,
2002). This inconsistency in findings could be a
result of having only studied group differences, not
taking into consideration that children with ODD
often have elevated levels of ADHD symptoms. 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.g., Nigg, Hinshaw, Carte,
& Treuting, 1998).
The fact that our results showed very similar pat-
terns of associations between the neuropsycholo-
gical measures and the two ADHD symptom
domains should be commented on. These results
may be taken to contrast with findings on school-
aged children suggesting that impaired executive
control is most strongly associated with inattention
symptoms (e.g., Chhabildas, Pennington, & Willcutt,
2001; Willcutt, Doyle, Nigg, Faraone, & Pennington,
2005). The apparent contrast may, however, be
understood by referring to the results reported by
Brocki and Bohlin (2006). They showed reciprocal
associations between the two ADHD symptom
domains and executive deficits in the late preschool
and early school-age years, whereas executive dys-
function was related only to inattention in older
school-aged children.
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 (Sonuga-
Barke et al., 2002; Berlin & Bohlin, 2002), 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.
1039
of ADHD has not been addressed in previous stud-
ies. Thus, this study takes the role of inhibitory
control as a potential neuropsychological marker
for ADHD a step further, by suggesting potentially
distinct inhibitory pathways between risk and
later-developing ADHD. Indeed, the results showed
that interference control within task, interference
control outside task, and prepotent response inhi-
bition predicted independent parts of the variance in
ADHD symptoms two years later. These results
contrast with Barkley’s (1997) proposition and the
previous empirical findings of, for example, Leung
and Connolly (1996) that it is interference within
task rather than interference outside the task that
seems most important in relation to ADHD. These
inconsistencies could be a result of the different
developmental levels of the samples studied (pre-
school vs. school age). In other words, it could be
speculated that the relative importance of different
types of inhibitory control in relation to ADHD dif-
fers as a function of age. This is an issue that awaits
empirical testing and should be of interest in future
studies examining ADHD from a developmental
perspective.
Concurrent and 2-year longitudinal relations
between working memory and behavioral
problem symptoms
In contrast to inhibitory control, working memory
did not correlate with concurrent or longitudinal
symptoms of either ADHD or ODD. These results are
in line with findings from the preschool study by
Sonuga-Barke and colleagues (2002), whereas most
studies of older children have found associations
between working memory and ADHD symptoms
(e.g., Martinussen et al., 2005, Martinussen & Tan-
nock, 2006; Willcutt et al., 2005). Although the
current study does not specifically address neuro-
psychological correlates of ADHD as a function of
age, a developmental explanation for this inconsist-
ency seems plausible, given the fact that working
memory processes are not sufficiently developed at
preschool age (Gathercole, Pickering, Ambridge, &
Wearing, 2004). In line with this developmental
reasoning, Barkley (1997), in elaborating his hybrid
model of ADHD, suggested that inhibitory control is
the ‘first’ impaired neuropsychological component in
ADHD, which in turn ‘sets the stage’ for impairments
in later-developing, more complex executive func-
tions, such as working memory and planning.
Corroborating Barkley’s hypothesis about develop-
mental 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,
whereas poor functioning with regard to later-
developing and more complex executive functions
such as working memory was associated only with
inattention symptoms for older school aged children.
1040 Karin C. Brocki et al.
It should be noted, however, that some preschool
studies do report relations between working memory
and ADHD (Mariani & Barkley, 1997; Sonuga-Barke
et al., 2003; Thorell & Wåhlstedt, 2006). Discrep-
ancies in results for working memory and ADHD in
preschool children are not easily explained, but may
be attributable to variations in samples and type of
measures used. Relating to the possibility of results
being task-specific, it should be acknowledged that
the working memory measures used in the current
study may not have been optimal. This explanation
especially relates to the spatial working memory
measure primarily tapping into the storage compon-
ent (i.e., short-term memory) of the working memory
system. However, this explanation is less relevant for
the lack of relation between backward word span
(commonly thought to be a working memory mea-
sure) and ADHD symptoms. It is currently unclear
both empirically and theoretically whether short-
term memory measures actually do capture working
memory in young children (Engle, Laughlin, Tuhol-
ski, & Conway, 1999). Thus, additional research
examining the link between working memory func-
tion, using verbal and spatial short-term memory as
well as working memory measures, and ADHD in the
preschool period is needed.
Summary and conclusions
To sum up, our results are supportive of the idea
that inhibitory control is an important component of
the early neuropsychology of ADHD rather than
ODD. 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. Our results are unique in showing
that three distinct inhibitory phenomena, interfer-
ence control within task, interference control outside
task, and prepotent response inhibition, constituted
independent predictors in explaining ADHD symp-
toms 2 years later. This result suggests several dis-
tinct inhibitory processes being associated with early
ADHD symptoms. With regard to working memory,
no relations to ADHD or ODD symptoms were
obtained. Further, early neuropsychological function
did contribute to the prediction of an increase in
ADHD symptoms over time. However, it was only
prepotent motor inhibition that predicted this
change in ADHD symptoms independently of the
other measures. This finding provides unique evid-
ence that early dysfunction in this particular type of
inhibitory control might be a strong neuropsycho-
logical predictor for later ADHD symptoms. Together,
the current findings stress the importance of study-
ing how different types of inhibitory control are
linked to ADHD symptom domains at different
developmental stages. Such maturational issues are
important, particularly when viewing ADHD as a
Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.
developmental disorder with deficits in underlying
neuropsychological components possibly varying
with child age.
Acknowledgement
This study was supported by a grant from The Bank
of Sweden Tercentenary Foundation.
Correspondence to
Karin C. Brocki, Department of Psychology, Uppsala
University, P.O. Box 1225, SE-751 42 Uppsala,
Sweden; Tel: +46 18 471 22 24; Fax: +46 18 471 21 23;
Email: Karin.Brocki@psyk.uu.se
References
American Psychiatric Association. (1994). Diagnostic
and statistical manual of mental disorders (4th edn).
Washington, DC: Author.
Baddeley, A.D. (1992). Working memory. Science, 255,
556–559.
Baddeley, A.D., & Hitch, G.J. (1994). Developments in
the concept of working memory. Neuropsychology, 8,
485–493.
Barkley, R.A. (1997). ADHD and the nature of self-
control. New York: Guilford Press.
Berlin, L., & Bohlin, G. (2002). Response inhibition,
hyperactivity and conduct problems among preschool
children. Journal of Clinical Child and Adolescent
Psychology, 31, 242–251.
Berlin, L., Bohlin, G., & Rydell, A-M. (2003). Relations
between inhibition, executive functioning, and
ADHD-symptoms: A longitudinal study from age 5
to 81/2. Child Neuropsychology, 9, 255–265.
Brocki, K.C., & Bohlin, G. (2004). Executive functions in
children age 6–13: A dimensional and developmental
study. Developmental Neuropsychology, 26, 571–593.
Brocki, K.C., & Bohlin, G. (2006). Developmental
change in the relation between executive functions
and symptoms of ADHD and co-occurring behavior
problems. Infant and Child Development, 15, 19–40.
Brophy, M., Taylor, E., & Hughes, C. (2002). To go or
not to go: Inhibitory control in hard to manage
children. Infant and Child Development, 11, 125–140.
Byrne, J.M., DeWolfe, N.A., & Bawden, H.N. (1998).
Assessment of attention deficit hyperactivity disorder
in preschoolers. Child Neuropsychology, 4, 49–66.
Castellanos, F.X., Sonuga-Barke, E.J.S., Milham, M.P.,
& Tannock, R. (2006). Characterizing cognition in
ADHD: Beyond executive dysfunction. Trends in
Cognitive Science, 10, 117–123.
Chhabildas, N., Pennington, B.F., & Willcutt, E.G.
(2001). A comparison of the neuropsychological pro-
files of the DSM-IV subtypes of ADHD. Journal of
Abnormal Child Psychology, 29, 529–540.
DuPaul, G.J., Power, T.J., Anastopoulos, A.D., & Reid,
R. (1998). ADHD Rating Scale IV. Checklists, norms,
and clinical interpretation. New York: Guilford Press.
Engle, R.W., Tuholski, S.W., Laughlin, J.E., & Conway,
A.R. (1999). Working memory, short-term memory,
Ó 2007 The Authors
 Preschool ADHD and ODD symptoms: inhibition and working memory
and general fluid intelligence: A latent-variable
approach. Journal of Experimental Psychology:
General, 128, 309–331.
Gathercole, S., Pickering, S.J., Ambridge, B., & Wear-
ing, H. (2004). The structure of working memory from
4 to 15 years of age. Developmental Psychology, 40,
177–190.
Gerstadt, C.L., Hong, Y.J., & Diamond, A. (1994). The
relationship between cognition and action: Perfor-
mance of children 31/2–7 years old on a Stroop-like
day–night test. Cognition, 53, 129–153.
Groth-Marnat, G. (1997). Handbook of psychological
assessment (3rd edn). New York: John Wiley & Sons.
Kalff, A.C., Hendriksen, J.G.M., Kroes, M., Vles, J.S.H.,
Steyaert, J., Feron, F.J.M., van Zeben, T.M.C.B., &
Jolles, J. (2002). Neurocognitive performance of 5- and
6-year old children who meet criteria for attention-
deficit/hyperactivity disorder at 18 months follow-up:
Results from a prospective population study. Journal
of Abnormal Child Psychology, 30, 589–598.
Klingberg, T. (2006). Development of superior frontal-
intraparietal network for visuo-spatial working mem-
ory. Neuropsychologia, 44, 2171–2177.
Korkman, M., Kemp, S.L., & Kirk, U. (1998/2000).
NEPSY – A Developmental Neuropsychological Assess-
ment. Manual. San Antonio, TX: Psychological Cor-
poration (Psykologiförlaget AB, Stockholm).
Leung, P.W.L., & Connolly, K.J. (1996). Distractibility
in hyperactive and conduct-disordered children.
Journal of Child Psychology and Psychiatry, 37,
305–312.
Mariani, M.A., & Barkley, R.A. (1997). Neuropsycholog-
ical and academic functioning in preschool boys with
Attention Deficit Hyperactivity Disorder. Develop-
mental Neuropsychology, 13, 111–129.
Martinussen, R., Hayden, J., Hogg-Johnson, S., &
Tannock, R. (2005). A meta-analysis of working
memory impairments in children with attention
deficit/hyperactivity disorder. Journal of American
Academy of Child and Adolescent Psychiatry, 44,
377–384.
Martinussen, R., & Tannock, R. (2006). Working mem-
ory impairments in children with attention deficit
hyperactivity disorder with and without comorbid
language learning disorders. Journal of Clinical and
Experimental Neuropsychology, 28, 1073–1094.
Moffitt, T.E. (1993). The neuropsychology of conduct
disorder. Development and Psychopathology, 5, 135–
151.
Nigg, J.T. (2000). On inhibition/disinhibition in devel-
opmental psychopathology: Views from cognitive and
personality psychology and a working inhibition
taxonomy. Psychological Bulletin, 126, 200–246.
Nigg, J.T. (2006). What causes ADHD? Understanding
what goes wrong and why. New York: The Guildford
Press.
Nigg, J.T., Hinshaw, S.P., Carte, E.T., & Treuting, J.J.
(1998). Neuropsychological correlates of childhood
attention-deficit/hyperactivity disorder: Explainable
by comorbid disruptive behavior or reading prob-
lems? Journal of Abnormal Psychology, 107, 468–
480.
Nigg, J.T., Willcutt, E.G., Doyle, A.E., & Sonuga-Barke,
E.J.S. (2005). Causal heterogeneity in attention-def-
icit/hyperactivity disorder: Do we need neuropsycho-
Ó 2007 The Authors
Journal compilation Ó 2007 Association for Child and Adolescent Mental Health.
1041
logically impaired subtypes? Biological Psychiatry,
57, 1224–1230.
Oosterlaan, J., Logan, G.D., & Sergeant, J.A. (1998).
Response inhibition in AD/HD, CD, comorbid AD/
HD + CD, anxious, and control children: A meta-
analysis of studies with the stop task. Journal of Child
Psychology and Psychiatry, 39, 411–425.
Oosterlaan, J., Scheres, A., & Sergeant, J.A. (2005).
Which executive functioning deficits are associated
with AD/HD, ODD/CD and comorbid AD/HD + ODD/
CD? Journal of Abnormal Child Psychology, 33, 69–85.
Séguin, J.R., Boulerice, B., Harden, P.W., Tremblay,
R.E., & Phil, R.O. (1999). Executive functions and
physical aggression after controlling for attention
deficit hyperactivity disorder, general memory, and
IQ. Journal of Child Psychology and Psychiatry, 40,
1197–1208.
Sergeant, J.A., Geurts, H., & Oosterlaan, J. (2002). How
specific is a deficit of executive functioning for
attention-deficit/hyperactivity disorder? Behavioural
Brain Research, 130, 3–28.
Sonuga-Barke, E.J.S., Auerbach, J., Campbell, S.B.,
Daley, D., & Thompson, M. (2005). Varieties of
preschool hyperactivity: Multiple pathways from risk
to disorder. Developmental Science, 8, 141–150.
Sonuga-Barke, E.J.S., Dalen, L., Daley, D., & Reming-
ton, B. (2002). Are planning, working memory, and
inhibition associated with individual differences in
preschool ADHD symptoms? Developmental Neuro-
psychology, 21, 255–272.
Sonuga-Barke, E.J.S., Dalen, L., & Remington, B.
(2003). Do executive and delay aversion make inde-
pendent contributions to preschool attention-deficit/
hyperactivity disorder symptoms. Journal of American
Child and Adolescent Psychiatry, 42, 1335–1342.
Smith, E.E., & Jonides, J. (1999). Storage and executive
processes in the frontal lobes. Science, 283, 1657–
1661.
Speltz, M.L., DeKlyen, M., Calderon, R. Greenberg,
M.T., & Fisher, P.A. (1999). Neuropsychological char-
acteristics and test behaviors of boys with early onset
conduct problems. Journal of Abnormal Psychology,
108, 315–325.
Thorell, L.B., & Wåhlstedt, C. (2006). Executive func-
tioning deficits in relation to symptoms of ADHD and/
or ODD in preschool children. Infant and Child
Development, 15, 503–518.
Waschbusch, D.A. (2002). A meta-analytic examination
of comorbid hyperactive-impulsive-attention prob-
lems and conduct problems. Psychological Bulletin,
128, 118–150.
Wechsler, D. (1992/1994). Wechsler Intelligence Scale
for Children (3rd edn; Psykologiförlaget AB, Stock-
holm, Trans.). London: Psychological Corporation.
Westerberg, H., Hirvikoski, T., Forssberg, T., & Kling-
berg, T. (2004). Visuo-spatial working memory span:
A sensitive measure of cognitive deficits in children
with ADHD. Child Neuropsychology, 10, 155–161.
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 dis-
order: A meta-analytic review. Biological Psychiatry,
57, 1336–1346.
Manuscript accepted 21 June 2007