DEVELOPMENTAL NEUROPSYCHOLOGY, 28(3), 779–807

Copyright © 2005, Lawrence Erlbaum Associates, Inc.

Implicit Memory Development in

School-Aged Children With Attention
Deficit Hyperactivity Disorder (ADHD):
Conceptual Priming Deficit?
Matthew J. Burden
Department of Psychiatry and Behavioral Neurosciences
Wayne State University School of Medicine, Detroit, MI

David B. Mitchell
WellStar College of Health and Human Services
Kennesaw State University, GA

Previous research has shown that children with attention deficit hyperactivity disor-
der (ADHD) often demonstrate performance deficits on effortful, strategic memory
tasks, whereas relatively rote tasks of memory reveal no such deficit. Thus far, re-
search in this domain has focused primarily on explicit memory. This study exam-
ined performance on multiple measures of implicit and explicit memory in children
aged 7 to 14 years with and without ADHD. Memory for words and pictures was as-
sessed at 15-min and 24-hr intervals. ADHD and non-ADHD groups performed sim-
ilarly on tests of explicit memory (category-cued recall and recognition) and on per-
ceptual aspects of implicit memory (word stem completion and picture fragment
identification) as a function of age, retention interval, and stimulus format (i.e., pic-
ture or word). However, there was no evidence of priming on a conceptual implicit
memory test (category exemplar generation) for boys with ADHD. This type of con-
ceptual task, which is likely mediated by frontal systems, may indicate a unique
memory deficit associated with ADHD.

Children with attention deficit hyperactivity disorder (ADHD) often exhibit cogni-
tive and memory deficits (e.g., August, 1987; Benezra & Douglas, 1988;

Requests for reprints should be sent to Matthew J. Burden, Department of Psychiatry and Behav-
ioral Neurosciences, Wayne State University School of Medicine, 2751 E. Jefferson, Ste. 460, Detroit,
MI 48207. E-mail: mburden@wayne.edu
780 BURDEN AND MITCHELL

Borcherding, Thompson, Kruesi, Bartko, Rapoport, & Weingartner, 1988; O’Neill

& Douglas, 1996). Specific memory deficits associated with ADHD have become
better understood in recent studies, which tend to show deficits only for tasks that
depend on more complex, organizational components of memory (e.g., Cornoldi,
Barbieri, Gaiani, & Zocchi, 1999; Kaplan, Dewey, Crawford, & Fisher, 1998; Ott
& Lyman, 1993). Implicit and explicit memory are two forms of memory that have
often been contrasted with one another in other clinical and developmental con-
texts, but implicit memory has not been well-studied in ADHD. Implicit memory
refers to an influence or facilitation in performance based on some previous expe-
rience in the absence of conscious recollection, whereas explicit memory depends
on conscious recollection (Graf & Schacter, 1985). This investigation was de-
signed to examine implicit memory phenomena in school-aged children with
ADHD. Only one other study has examined implicit memory in a similar context,
focusing on perceptual implicit memory in ADHD (Aloisi, McKone, & Heubeck,
2004). However, there are distinct perceptual and conceptual forms of implicit
memory that have been revealed as a function of developmental age (Perruchet,
Frazier, & Lautrey, 1995), intelligence (Komatsu, Naito, & Fuke, 1996), divided
attention (Mulligan, 1997), depression (Jenkins & McDowall, 2001), and memory
impairments (Blaxton, 1992; Lazzara, Yonelinas, & Ober, 2001). Moreover, per-
ceptual and conceptual implicit memory processes appear to be mediated by dis-
tinct brain structures and functions (Blaxton, Bookheimer, Zeffiro, Figlozzi,
Gaillard, & Theodore, 1996). Thus, an investigation of these unique processes may
offer further insight into specificity for memory deficits associated with ADHD.

IMPLICIT MEMORY

The modern concept of implicit memory stems largely from the work of War-
rington and Weiskrantz (1968), who discovered spared forms of memory in amne-
sia. For example, when amnesic patients were presented with degraded test stim-
uli, they were better able to solve previously presented items even though no
explicit memory (i.e., conscious recollection) was evident for those items. This
particular paradigm for assessing implicit memory is known as repetition prim-
ing—items from study that are repeated at test influence the participant to respond
with the previously studied items. Repetition priming, which is simply calculated
as the difference in the proportion of test items solved with previously studied ver-
sus unstudied (baseline) stimuli, also has been used extensively in normal popula-
tions as an index of implicit memory. Experimental manipulations that tend to en-
hance explicit memory (e.g., greater depth of processing) often have little or no
impact on implicit memory (e.g., Jacoby & Dallas, 1981). Variables such as reten-
tion interval often reveal stable implicit memory performance over time despite
declines in explicit memory (e.g., Mitchell & Brown, 1988; Tulving, Schacter, &
 IMPLICIT MEMORY IN ADHD 781

Stark, 1982). Age-related improvements in explicit memory across childhood and

subsequent declines in older adulthood are found in contrast to age-invariant im-
plicit memory (see Anooshian, 1998; Mitchell, 1993, for reviews).
Despite the generally robust nature of implicit memory, dissociations between
perceptual and conceptual processes have challenged the notion of invariance. Per-
ceptual tests rely on the overlap of physical features between study and test,
whereas conceptual tests rely solely on the overlap of semantic cues between study
and test (Blaxton, 1989). For example, perceptual priming in a word fragment
completion test is evident when previously studied words are used to solve test
fragments (e.g., basket to b_s_et); however, pictures corresponding to those same
words provide little or no facilitation in performance (Roediger & Srinivas, 1993).
Category exemplar generation (CEG) is one example of a conceptual implicit task,
because the only test prompt is a category heading. No overlapping perceptually
based cues exist (e.g., Greenbaum & Graf, 1989) and stimulus format effects (e.g.,
picture vs. word) are generally absent (Weldon & Coyote, 1996).
In the cognitive developmental literature, dissociations between implicit and
explicit memory have been well-documented at school age, with stable implicit
memory performance despite age-related improvements in explicit memory (see
Naito & Komatsu, 1993, for a review). However, the notion of implicit memory
invariance with age has been based primarily on perceptual tasks (see Billingsley,
Smith, & McAndrews, 2002, for an exception). Komatsu et al. (1996) addressed
this issue by manipulating perceptual and conceptual processing during encod-
ing—children either read a word bracketed in a sentence (perceptual) or generated
the missing word (conceptual). In the first experiment, a comparison group of
adults performed similarly under perceptual and conceptual conditions. Develop-
mentally, second and sixth grade children performed equally on the perceptual
test, but the older children showed more priming on the conceptual task. In a sec-
ond experiment, performance was comparable between children with and without
mental retardation on the perceptual test, but children with mental retardation were
significantly impaired on the conceptual test. These results were interpreted as evi-
dence that conceptual priming requires some form of higher order processing that
is enhanced by both age and intelligence; by contrast, perceptual priming may be
more rudimentary and thus unaffected by these variables.
Conceptual implicit memory tends to be more adversely affected than percep-
tual implicit memory when other forms of cognitive functioning are compromised.
For example, patients with Alzheimer’s disease tend to show deficits on concep-
tual priming despite normal performance on perceptual tests (e.g., Lazzara et al.,
2001). Clinically depressed patients have also shown deficits on conceptual prim-
ing tasks despite normal explicit free recall (Jenkins & McDowall, 2001), and a
similar distinction has been supported with mood-congruent memory in depres-
sion (Watkins, Martin, & Stern, 2000). Although there has no been direct evidence
regarding conceptual implicit memory in relation to ADHD, Mulligan and
782 BURDEN AND MITCHELL

Hartman (1996) found that dividing attention in normal adults led to diminished
performance on category generation priming, a conceptual task, whereas word
fragment priming, a perceptual task, was unaltered. Similarly, dividing attention
during encoding appears to produce more noticeable effects on conceptual priming
than perceptual priming in both young adults (Mulligan, 1997) and older adults
(Light, Prull, & Kennison, 2000). The dissociable nature of perceptual and concep-
tual priming is supported by neuroimaging evidence, which suggests that different
neurological structures in the brain support these distinct processes (Blaxton et al.,
1996). Cabeza and Nyberg (2000) suggested greater involvement of frontal and
prefrontal cortical functioning on conceptual priming tasks, whereas perceptual
priming is more dependent on occipital and subcortical functioning. Given that
frontal systems dysfunction largely characterizes ADHD (Casey et al., 1997;
Castellanos et al., 1996; Ernst, Liebenauer, King, Fitzgerald, Cohen, & Zametkin,
1994; Filipek, Semrud-Clikeman, Steingard, Renshaw, Kennedy, & Biederman,
1997; Lazar & Frank, 1998; Sieg, Gaffney, Preston, & Hellings, 1995; Zametkin et
al., 1993; Zametkin et al., 1990), differentiating between perceptual and concep-
tual forms of implicit memory may lead to a better understanding of specific mem-
ory deficits in children with ADHD.

ADHD AND MEMORY

According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.
[DSM–IV]; American Psychiatric Association, 1994), ADHD is characterized by
symptoms of poor sustained attention, impulsiveness, and hyperactivity, with pro-
posed subtypes: predominantly inattentive, predominantly hyperactive-impulsive,
and combined types. There are five main criteria for diagnosis: (a) inattentive
and/or hyperactive-impulsive symptoms (at least 6 of 9 listed items for each) that
have persisted for at least 6 months and are maladaptive and inappropriate for de-
velopmental age, (b) some symptoms that caused impairment were present before
age 7, (c) some impairment is present in more than one setting (e.g., home and
school), (d) there is clear evidence of clinically significant impairment in social or
academic functioning, and (e) symptoms are not associated solely with other disor-
ders and are not better accounted for by other disorders.
Memory research in children with ADHD has typically been focused on ex-
plicit forms of memory, such as working memory, which is often impaired in
ADHD (Berlin, Bohlin, Nyberg, & Janols, 2004; McInnes, Humphries,
Hogg-Johnson, & Tannock, 2003). Barkley (1997) suggested that particular defi-
cits in working memory may arise in ADHD because of an associated inability to
prolong mental events, and several studies have shown that methylphenidate im-
proves working memory performance dramatically (Kempton, Vance, Maruff,
Luk, Costin, & Pantelis, 1999; Mehta, Owen, Sahakian, Mavaddat, Pickard, &
 IMPLICIT MEMORY IN ADHD 783

Robbins, 2000; Tannock, Ickowicz, & Schachar, 1995). However, other studies
have shown that effects on working memory and other executive function tasks of-
ten disappear after adjusting for confounding factors such as lower IQ (Kuntsi,
Oosterlaan, & Stevenson, 2001; Mahone et al., 2002; Scheres et al., 2004). More-
over, there is often an absence of memory differences regardless of medication or
IQ variables (e.g., French, Zentall, & Bennett, 2001). Karatekin (2004) found that
children with ADHD do not appear to have generalized impairments in working
memory, but they may be more prone to specific impairments in working memory
related to the ability to divide attention during tasks. This finding supports sug-
gestions that inconsistencies for finding memory differences in ADHD across
the literature may stem from a lack of specificity when characterizing memory
deficits (e.g., Kaplan et al., 1998; Ott & Lyman, 1993). For example, although at-
tention and processing deficits may occur during initial stages of memory for
children with ADHD, long-term retention of learned material is comparable to
children without ADHD (Cahn & Marcotte, 1995; Kaplan et al., 1998). Mealer,
Morgan, and Luscomb (1996) found that children with ADHD had more memory
difficulties than their peers without ADHD on general memory, but more particu-
larly on visual memory and verbal learning, which are more dependent on active
processing and storage of information during the test session. By contrast, the
ADHD group performed comparably to the non-ADHD group when stimuli
were readily visible during testing (e.g., picture completion, picture arrange-
ment).
Children with ADHD have also demonstrated a capability to effectively meet
simple memory demands (e.g., Benezra & Douglas, 1988; McGee, Williams,
Moffit, & Anderson, 1989; Ott & Lyman, 1993; Siegel & Ryan, 1989), whereas
performance on more complex tasks is more likely to be compromised (e.g., Au-
gust, 1987; Borcherding et al., 1988; Douglas & Benezra, 1990). For example, Ott
and Lyman (1993) found that free recall, an effortful task, was impaired in children
with ADHD, but that relatively automatic memory for spatial location was intact.
Children with ADHD may be more likely to adopt an effortless rehearsal style that
could lead to inferior recall. For example, O’Neill and Douglas (1996) tested the
effectiveness of an overt rehearsal procedure to assess strategy use in boys with
ADHD on a self-paced, multitrial list-learning task. The boys with ADHD showed
considerably lower word recall than boys in a matched comparison group, spent
significantly less time rehearsing, and showed less use of multi-item rehearsal
strategy, even though they did improve over each of the five trials. Strategic mem-
ory deficits as well as poorer metacognitive knowledge (e.g., effective use of mne-
monic strategies) have also been found in sixth to eighth graders with ADHD, who
demonstrate lower overall memory performance, poorer memory for categorical
adjacencies, and a higher number of intrusion errors (Cornoldi et al., 1999). Simi-
larly, a recent study by Siklos and Kerns (2004) showed that children with ADHD
did not show deficits in retrospective memory (i.e., they could recall rules and
784 BURDEN AND MITCHELL

carry out task instructions), but they were unable to generate useful strategies and
had problems monitoring their ongoing activity throughout a multitasking test.

THE CURRENT STUDY

The goal of this study was to provide a comprehensive examination of implicit and
explicit memory functioning in school-aged children with ADHD. Multiple mea-
sures of implicit and explicit memory were employed at 15-min and 24-hr inter-
vals. Both perceptual and conceptual aspects of implicit memory were examined,
and distinctions were made between explicit memory tests requiring more or less
organizational strategy and effort. Effects of age, gender, intellectual ability, and
other participant characteristics were also considered.
The generally robust nature of implicit memory suggests that its functioning is
likely to be normal in children with ADHD for perceptual tasks. Indeed, in the only
comparable study of which we are aware, there was no ADHD-related deficit in
picture fragment identification (PFI) priming, a perceptual task (Aloisi et al.,
2004). A second question relates to conceptual implicit memory, which has not
been investigated previously in ADHD. The dissociations between perceptual and
conceptual forms of implicit memory demonstrated in other studies—coupled
with their purported underlying neurobiological correlates—suggest that differ-
ences associated with ADHD may emerge for the conceptual task. Because
children with ADHD tend to have more difficulty with relatively complex, strate-
gic/organizational, or effortful components of memory compared to more auto-
matic ones (e.g., Cornoldi et al., 1999; Douglas & Benezra, 1990), the percep-
tual–conceptual distinction may offer new insights into memory functioning in
these children.
For implicit memory, we predicted that (a) both ADHD and non-ADHD groups
would show a greater magnitude of same-format (e.g., word-to-word) compared to
cross-format (e.g., word-to-picture) priming for the perceptual tasks of word stem
completion (WSC) and PFI and (b) overall levels of priming would not differ be-
tween groups. However, we anticipated that (c) group differences for CEG, the
conceptual implicit memory test, might emerge. Regarding explicit memory, we
predicted that performance would (d) improve with age and intellectual ability, (e)
diminish over time, and (f) show picture superiority effects (i.e., pictures remem-
bered better than words). Finally, group differences were not expected for rela-
tively effortless recognition memory (RM), but we predicted (g) that the more
effortful and organizational strategies required for category-cued recall (CCR)
would distinguish between groups.
An advantage to examining a comprehensive set of implicit and explicit mem-
ory measures (e.g., age effects, cross-format priming, time interval, etc.) is that it
ensures that the priming measures are working as expected. If the expected signifi-
 IMPLICIT MEMORY IN ADHD 785

cant and nonsignificant patterns obtain for numerous aspects of implicit memory
measures, then conclusions regarding group differences are strengthened because
they are less likely to be an artifact.

METHOD

Participants
Seventy eight children from six different schools within a predominantly White,
Midwest school district took part in the study. Thirty children who were identified
as having ADHD (M = 10 yrs, 0 months; range = 7 yrs, 6 months to 14 yrs, 0
months; 24 boys, 6 girls) and 48 children without ADHD (M = 10 yrs, 0 months;
range 7 yrs, 1 month to 14 yrs, 1 month; 35 boys, 13 girls) were matched as closely
as possible for age, gender, and Otis–Lennon School Ability Test Total (the intel-
lectual ability measure). Although there were no significant differences by gender,
t(53) = .56, or with age, F(1, 53) = .04, the non-ADHD group performed better on
the Otis–Lennon, M = 109.5 versus 100.1, t(53) = 2.8, p < .05. Otis–Lennon scores
were available only for 21 children with ADHD (70.0%) and 35 non-ADHD
(72.9%); the youngest participating children had not yet taken this test in school.
Children with ADHD were identified through the school’s “Health Concerns
List,” having received an ADHD diagnosis previously by a clinician or physician
within the past year. Specific information about the diagnosis, such as subtype,
was not available. However, care was taken to recruit children without major aca-
demic problems or potential comorbid disorders (e.g., conduct disorder) that were
listed on the Health Concerns List. Only 64 of the 2,263 children within the eligi-
ble age range (2.8%) were identified with ADHD in the Health Concerns List after
these considerations. These children were most often mainstreamed into classes
with their non-ADHD peers. However, the high prevalence of learning disability
(LD) associated with ADHD in this population precluded the possibility to ex-
clude children on the basis of LD (see also August & Garfinkel, 1990). LD was
characterized by poor classroom functioning, one or more processing deficits (per-
ception, memory, association, integration, conceptualization, reasoning, applica-
tion, and expression), and a significant discrepancy between potential and achieve-
ment on a standardized test. A trained school psychologist had made these LD
assessments within the school year. Specific measures were not available. In this
study, 17 of 30 (56.7%) in the ADHD group had also been identified with LD; in
addition, 4 of 48 (8.3%) in the non-ADHD group had been identified with LD.
Twenty four of 30 (80.0%) of the ADHD group were taking medication regularly
for the disorder and medication effects were active during testing; no children in
the non-ADHD group were on similar medication. At the request of school admin-
istrators and parents who volunteered to participate in this study, the ADHD group
786 BURDEN AND MITCHELL

did not discontinue medication for testing (see also Aloisi et al., 2004). Although
this study was not medication-controlled, it provides information on ecologically
valid memory performance—that is, the children with ADHD in this study per-
formed as well as they might have on any other typical school day, unaltered from
their daily routine and learning environment.
For purposes of maintaining item and test counterbalancing integrity, original
ADHD groupings (n = 30 vs. n = 48) were used for primary analyses. However, ad-
ditional analyses in the results section address the potential confounding effects of
intellectual ability (Otis–Lennon Total), LD, and active medication for ADHD.
Two other potentially confounding influences—anxiety and oppositional behav-
ior—are also addressed in the additional analyses. These two measures were part
of the Conners’ Ratings Scales—Revised (Conners, 1997) administered to parents
(CPRS) and teachers (CTRS) to corroborate the original ADHD diagnoses from
the Health Concerns List. The CPRS and CTRS also allowed further investigation
into potential effects of Inattentive versus Hyperactive-Impulsive subtypes in the
additional analyses. Parents were instructed to rate the child’s behavior off medica-
tion. Teachers were not asked to rate the child’s behavior “on” or “off” medication,
but rather to base their ratings on the child’s typical behavior in the classroom,
which was most likely influenced by medication use. Table 1 provides subscale
scores for both CPRS and CTRS, subdivided according to the original ADHD or
non-ADHD groupings. As expected, ADHD-related CPRS and CTRS ratings dis-
tinguished between the original ADHD groupings—for example, for CPRS
DSM–IV ADHD Total score, M = 70.0 versus 48.9; for CTRS, M = 61.2 versus
48.2; also, the non-ADHD group fell well within the normal range on average on
these scales, M < 55.0 (see Table 1). Significant correlations among the DSM–IV
scales (i.e., Inattentive, Hyperactive-Impulsive, and ADHD Total) were also evi-
dent from both parent and teacher ratings (Table 2).

Materials and Design

A total of 120 items from the Snodgrass and Vanderwart (1980) standardized pic-
ture set were assigned to the various encoding and test conditions as word, picture,
or baseline (not seen, and therefore, unprimed) items, and counterbalanced so that
each item was used equally often in each condition, forming six unique sets of
study-test items. Items were chosen semirandomly, based on certain constraints
(e.g., a fixed number of exemplars per given category could not be exceeded; the
word stem of a given item was only used once per set—three letters most often,
two letters for three-letter words). Implicit memory tests included WSC, CEG, and
PFI; explicit memory tests included RM and category-cued recall (CCR).
Items for WSC and PFI were chosen according to high name agreement (or low
H value; mean H = .14, range = 0–.53), and picture fragment stimuli came from the
Snodgrass and Corwin (1988) standardized set. For each individual on the implicit
 TABLE 1
Scores From Subscales of Conners’ Parent Rating Scales (CPRS) and Conners’ Teacher Rating Scales (CTRS)

DSM Subscales Behavior Subscales Conners Subscales DSM–IV Scales

Variable DSM–IS DSM–HS A–OPP B–COG C–HY D–ANX E–PER F–SOC G–PSY H–CADH I–CGR J–CGE K–CGT L–IN M–HI N–TOT

CPRS
ADHD (n = 28)
M 2.5** 2.4** 64.7** 65.6** 70.3** 56.3** 56.4** 63.5** 55.9 67.4** 68.1** 61.2** 67.6** 67.0** 71.1** 70.0**
SD 2.5 2.5 14.3 9.4 13.0 12.4 10.0 15.6 11.8 8.8 10.1 14.8 11.2 10.6 12.3 10.4
Non-ADHD (n = 40)
M 0.1 0.2 47.4 48.9 49.1 49.2 47.3 47.9 50.2 48.1 47.7 46.6 47.1 48.0 50.0 48.9
SD 0.5 0.6 7.2 7.3 7.7 8.5 6.4 5.0 8.0 7.5 6.6 6.8 6.6 7.5 8.4 7.2
CTRS
ADHD (n = 29)
M 2.5** 1.1** 56.8* 58.9** 59.6** 57.1 49.2 59.2** 62.7** 63.4** 58.3** 63.2** 62.0** 58.3** 61.2**
SD 3.0 1.8 13.3 11.0 14.3 14.0 7.3 14.6 12.6 13.9 13.1 13.6 11.8 14.6 12.8
Non-ADHD (n = 44)
M 0.4 0.2 50.4 48.0 48.5 51.2 50.3 50.3 48.5 49.3 48.9 49.0 48.5 48.1 48.2
SD 1.1 0.6 9.3 7.6 7.1 11.7 10.2 9.5 8.1 9.2 7.5 8.5 7.4 6.9 7.2

Note. Tabled values are rounded to the nearest tenth. Significant differences between attention deficit/hyperactivity disorder (ADHD) and non-ADHD groups are
indicated. DSM–IV = Diagnostic and Statistical Manual of Mental Disorders (4th ed.); DSM–IS = DSM–IV Inattentive Subscale; DSM–HS = DSM–IV Hyperactive/Im-
pulsive Subscale; A–OPP = Oppositional; B–COG = Cognitive Problems/Inattention; C–HY = Hyperactivity; D–ANX = Anxious/Shy; E–PER = Perfectionism; F–SOC
= Social Problems; G–PSY = Psychosomatic Problems; H–CADH = Conners ADHD Index; I–CGR = Conners Global Restlessness Index; J–CGE = Conners Global
Emotional Liability Index; K–CGT = Conners Global Total; L–IN = DSM–IV Inattentive; M–HI = DSM–IV Hyperactive/Impulsive; N–TOT = DSM–IV ADHD Total. All
subscale scores except for the DSM subscales are presented as T-scores.
*p < .05. **p < .01.

787
788 BURDEN AND MITCHELL

TABLE 2
Intercorrelations Among Conners Parent and Teacher Diagnostic
and Statistical Manual of Mental Disorders (4th ed.) Scales
With Original ADHD Diagnosis

Measure 1 2 3 4 5 6 7

1. ADHD (original) — .71** .67** .75** .55** .35** .51**

2. CPRS–Inattention 55 — .67** .91** .44** .29* .42**
3. CPRS–Hyperactivity 51 51 — .91** .27 .28* .31*
4. CPRS–ADHD Total 51 51 51 — .39** .32* .40**
5. CTRS–Inattention 57 49 49 49 — .64** .93**
6. CTRS–Hyperactivity 57 49 49 49 57 — .88**
7. CTRS–ADHD Total 57 49 49 49 57 57 —

Note. ADHD = attention deficit/hyperactivity disorder; CPRS = Conners Parent Rating Scale;
CTRS = Conners Teacher Rating Scale. Group N for each Pearson r in italics.
*p < .05. **p < .01.

tests (WSC, CEG, PFI), two thirds of the items (16 items or 4 categories) served as
primes (words and pictures, equally often), with the remaining third as baseline
items (8 items or 2 categories) for the unprimed condition. On the explicit RM
tests, half of the pictures and words (12 items) had been seen previously and half
had not (12 items); CCR differed from CEG only in instructions. Each item pre-
sented at study had only one corresponding test item at Time 1, and there was no
overlap of test items between implicit and explicit measures (e.g., if “umbrella”
had been presented at study and “umb___” appeared in WSC, that item would not
appear in any other implicit test at Time 1, or in any explicit test at either Time 1 or
2). To minimize the possibility of explicit contamination—that is, the intentional
use of conscious recollection on an implicit test (see Mitchell, 1995; Mitchell &
Bruss, 2003)—implicit tests were always administered first and the order was held
constant: WSC, CEG, PFI, RM, and CCR at Time 1; PFI, WSC, and RM at Time 2.
CEG and CCR were not assessed at Time 2 because test items were no longer
unique.
All testing was conducted on a Dell Latitude notebook computer with 13-inch
color screen, using PowerPoint (Microsoft Office 2000). Picture and picture frag-
ment stimuli were presented as black line drawings/fragments on a white back-
ground, centered on the screen, and not exceeding a 9 × 9 cm space. All word and
word stem stimuli were presented in black, lowercase letters on a white back-
ground using Book Antiqua font, size 48. The child was seated 50 to 60 cm from
the display screen. Timing for presentation of all stimuli was programmed into
PowerPoint; however, if the child provided a response prior to the time limit, the
experimenter would continue manually to the next stimulus by pressing the
“down” arrow key.
 IMPLICIT MEMORY IN ADHD 789

Procedure
All children were tested individually in a quiet room in their school, free from
other distractions. The experimenter recorded all responses on a preformatted
sheet. Prior to testing, each participating child returned a consent form signed by a
parent and gave verbal assent to participate. All methods and procedures were ap-
proved by the Loyola University Institutional Review Board for the Protection of
Human Research Subjects. Before proceeding with any task, the experimenter de-
scribed the task and provided examples to ensure that the child understood instruc-
tions. Testing occurred over the course of two consecutive school days, and ap-
proximately 60 to 75 min total time was required of each child to complete the
sessions.

Encoding phase. For the encoding phase, each child was asked to say the
name of the picture or read the word as it appeared on the computer screen, as
quickly and accurately as possible. Seven practice pictures and words were given
first. Seventy two pictures and words were then presented for 2 sec each, with a
1-sec interstimulus interval (ISI). Total time for the encoding phase was approxi-
mately 4 min.

Distraction task. The Wisconsin Card Sorting Test (WCST; Heaton,

Chelune, Talley, Kay, & Curtiss, 1993) served to extend the retention interval be-
tween encoding and test phases (approximately 15 min) at Time 1. For this test,
each child was instructed to try to match the card appearing at the bottom of the
computer screen with one of the four cards at the top, and make decisions accord-
ing to the “RIGHT” or “WRONG” message displayed upon responding. No time
limit was imposed for this task, and the experimenter answered only general ques-
tions that did not reveal the nature of the task.

Implicit Tests
WSC. After the WCST was completed, children were shown several word
stems on a practice sheet with sample solutions (e.g., “wa___” with “water”), and
then asked to try to solve a few on their own. For WSC, they were then presented
with 24 word stems (8 target words, 8 target pictures, 8 baseline items), and asked
to solve each with the first word that came to mind. Each word stem was presented
for 5 sec, with 2-sec ISI. If no solution for a particular item was generated, the next
item was presented.

CEG. For CEG, the names of six categories were given (4 targets, 2 baseline)
one at a time (Furniture, Human Body Parts, Musical Instruments, Kitchen Uten-
sils, Carpenter’s Tools, and Vegetables). “Coins” was given as the practice cate-
790 BURDEN AND MITCHELL

gory. The child was asked to name the first five items that came to mind from that
category and respond as quickly and accurately as possible; the 1-min time limit
for each category was also made known.

PFI. The procedure for PFI was identical to WSC, with the exception that test
items consisted of picture fragments rather than word stems.

Explicit Tests
RM. For RM, children were instructed to think back to pictures and words
from the encoding phase, and then to respond “yes” or “no” depending on their
memory for the item. Twelve intact targets (6 pictures, 6 words) and 12 intact
distractors (6 pictures, 6 words) were presented for 3 sec with a 2-sec ISI for the
maximum time. If the child responded immediately, the experimenter would pro-
ceed to the next slide.

CCR. The procedure and items for CCR were identical to CEG except for
task instructions, which explicitly asked for recall of items for a given category
from the encoding phase; no 1-min time limit was imposed.

Posttest Questionnaire
At the conclusion of Time 1 testing, all participants were asked about their experi-
ence to assess any explicit contamination that may have occurred. Specific ques-
tions included: (a) “Why do you think we saw all those words and pictures at the
beginning?” and (b) “Did you think they helped you with any of the games we
played, or not? Which ones?” and (c) “Did you think I showed them to you to test
your eyesight?” This last question was included to see assess bias toward answer-
ing “yes” to any question asked by the experimenter. Children were not told if their
answers were correct or not, but they were asked if they wanted to do some similar
tasks the next day (all agreed to participate again). The nature of the study as a
memory study was not revealed until the conclusion of Time 2. All testing at Time
1 was completed within 1 hr.

Time 2 Tests
At the 24-hr delay, children were again presented with WSC, PFI, and RM tests.
Procedures for each of these tests were identical to those at Time 1. Upon comple-
tion of these tests, the children were given a verbal explanation of the study and the
opportunity to ask any questions. Parents and school staff were given a written de-
scription of the rationale for the study at the study conclusion. Time 2 tests were
completed within 15 min.
 IMPLICIT MEMORY IN ADHD 791

RESULTS

Overall Priming
Planned one-sample t tests were conducted across groups to confirm that the im-
plicit measures reflected priming significantly different from zero (target word or
picture – baseline). Alpha levels were set to p < .05 for significance; all values
where p ≥ .05 were considered nonsignificant. Separate analyses were conducted
for Time 1 (N = 78) and Time 2 (N = 76); the lower N at Time 2 reflects the attrition
of two boys with ADHD, who were absent from school at the 24-hr delay. At Time
1, all four measures expected to demonstrate priming were significantly greater
than zero: word priming for WSC (WSCw), t(77) = 4.0, p < .01; word priming for
CEG (CEGw), t(77) = 2.2, p < .05; picture priming for CEG (CEGp), t(77) = 4.3, p
< .01 ; and picture priming for PFI (PFIp), t(77) = 5.6, p < .01. There was no evi-
dence of cross-format priming—that is, neither picture priming for WSC (WSCp)
nor word priming for PFI (PFIw) was significant. Results at Time 2 revealed simi-
lar patterns of significance for same-format priming, WSCw, t(75) = 4.5, p < .01;
PFIp, t(75) = 7.32, p < .01; and again, no significant cross-format priming.
General linear model univariate tests were used to examine effects of group
(ADHD vs. non-ADHD), gender, and age at both time intervals. Main effects for
group, gender (fixed factors), and age (covariate) were assessed in each analysis,
and interaction terms were removed from the model if nonsignificant. At both
Time 1 and 2, there were no significant group, gender, or age effects for WSCw,
WSCp, PFIp, and PFIw (all p values ≥ .05). For CEG at Time 1, however, a Group
× Gender interaction was evident, CEGw, F(1,73) = 5.1, p < .05; and CEGp,
F(1,73) = 10.4, p < .01. As illustrated in Figure 1, this interaction revealed that
boys with ADHD showed significantly less priming than girls with ADHD and
children in the non-ADHD group; furthermore, priming was not significantly dif-
ferent from zero for either CEGp or CEGw for boys with ADHD. In addition, a
post hoc one-sample t test revealed that overall CEG priming—a composite aver-
age of word and picture priming—was reliable for the small subgroup of girls with
ADHD (n = 6), M = .18, t(5) = 4.3, p < .01. Moreover, results using this measure for
overall CEG priming revealed that only 3 out of 24 boys with ADHD (12.5%)
showed overall CEG priming greater than 7% (i.e., more than one item) compared
to 22 out of 35 boys without ADHD (62.9%) who showed at least this minimal
amount of overall CEG priming.
Table 3 provides unadjusted means for targets, baseline, and priming for ADHD
versus non-ADHD groups. The results of planned univariate group comparisons in
Table 3 showed higher baseline scores for CEG in the ADHD group overall,
prompting an analysis to address the concern that the deficit in boys with ADHD
could be attributable to less “room” for priming when using the standard absolute
difference method (target – baseline). Snodgrass (1989) recommended use of a rel-
792 BURDEN AND MITCHELL

FIGURE 1 Category exemplar generation priming differences as a function of attention defi-

cit hyperactivity disorder group and gender (standard error bars pictured).

ative priming measure (baseline – target / baseline – 1) when baseline differences

exist between groups, and other developmental studies have also adopted this addi-
tional priming method to address similar concerns (e.g., Komatsu et al., 1996). In
this analysis conducted with boys only, results using the relative priming method
were nearly identical to the absolute method and CEG was the only source of sig-
nificant difference between ADHD and non-ADHD groups: CEGw, F(1, 57) =
10.1, p < .01; CEGp, F(1, 57) = 19.3, p < .01. It is also important to note that signif-
icant baseline discrepancies were found for PFI at Time 1 and for WSC at Time 2,
but they favored the non-ADHD group (Table 3). Nonetheless, both groups
showed significant and comparable priming on these two tasks. Moreover, there
were no differences in the number of items generated on CEG by group, indicating
comparable ability to complete the task with valid responses. Thus, these findings
suggest that baseline differences between groups did not prevent priming and the
CEG deficit found in boys with ADHD does not appear to be due to chance.

Overall Explicit Memory

Means and standard deviations for the explicit measures are also presented by
group in Table 3. For the explicit tests, CCR was simply calculated as the absolute
number of words (CCRw) or pictures (CCRp) recalled in the correct format (as-
sessed at Time 1 only). RM (for both pictures and words) was calculated as hits –
false alarms. Multiple linear regression was used to examine group, gender, and
 IMPLICIT MEMORY IN ADHD 793

TABLE 3
Means and Standard Deviations for Proportion of Items Identified Correctly
for Implicit and Explicit Memory Measures at Times 1 and 2

Time 1 Time 2

Non-ADHDa ADHDb Non-ADHDa ADHDb

Variable M SD M SD M SD M SD

Implicit tests
WSC
Words 0.52 0.25 0.45 0.27 0.47 0.17 0.43 0.19
Pictures 0.40 0.24 0.37 0.20 0.37 0.19 0.33 0.20
Baseline 0.36 0.18 0.35 0.20 0.38 0.15 0.30* 0.14
WSCwc 0.16 0.31 0.11 0.31 0.10 0.20 0.13 0.24
WSCpc 0.03 0.28 0.02 0.26 0.00 0.21 0.03 0.20
CEG
Words 0.37 0.14 0.35 0.11
Pictures 0.46 0.13 0.38* 0.18
Baseline 0.28 0.13 0.38** 0.12
CEGwc 0.10 0.21 –.02* 0.19
CEGpc 0.16 0.19 0.00** 0.21
PFI
Words 0.48 0.22 0.36* 0.24 0.45 0.17 0.41 0.19
Pictures 0.57 0.21 0.50 0.21 0.61 0.17 0.57 0.22
Baseline 0.44 0.18 0.33** 0.14 0.41 0.19 0.37 0.20
PFIwc 0.04 0.23 0.03 0.27 0.04 0.24 0.04 0.24
PFIpc 0.13 0.23 0.18 0.24 0.20 0.23 0.21 0.26
Explicit tests
RM
Words 4.00 1.60 3.97 1.61 2.45 1.36 2.59 1.63
Pictures 5.48 1.20 5.53 0.82 5.17 1.11 4.61* 1.10
CCR
Words 0.60 0.79 0.40 0.72
Pictures 1.88 1.42 1.47 1.31

Note. Significant differences between attention deficit/hyperactivity disorder (ADHD) and

non-ADHD groups are indicated within Time 1 or Time 2. WSC = word stem completion; CEG = cate-
gory exemplar generation; PFI = picture fragment identification; RM = recognition memory; CCR =
category cued recall; w = word; p = picture.
an = 48. bn = 30. cPriming = target word or picture – baseline.

*p < .05. **p < .01.

age effects on CCR and RM. For CCRw, a significant age effect was evident, β =
.28, p < .05, indicating improved cued recall with age. CCRp also revealed signifi-
cant improvement with age, β = .31, p < .01. No significant differences between
ADHD and non-ADHD groups were found on CCRw or CCRp. No age or group
differences were evident for word recognition, RMw, at Time 1 or Time 2. For
RMp at Time 1, a significant age effect emerged, β = .27, p < .05. For RMp at Time
794 BURDEN AND MITCHELL

2, there was a group effect indicating poorer performance in the ADHD versus
non-ADHD group, β = –.26, p < .05. No other significant main effects or interac-
tions emerged and no significant differences occurred for false alarm rates ana-
lyzed separately.

Implicit and Explicit Tests Over Time

General linear model repeated measures analysis was used to assess group effects
over time. This design included time (1 and 2) and implicit test (PFIp and WSCw)
as within-subjects factors, and group (ADHD vs. non-ADHD) and gender as be-
tween-subjects factors. As expected, no significant main effects or interactions
emerged from this analysis; rather, implicit memory performance remained at sim-
ilar levels for both tests over time.
The analyses for explicit tests were similar, except that RMw and RMp replaced
the implicit factors noted previously. In contrast to results of the implicit tests,
main effects of time were found for RMw, indicating the expected decline in rec-
ognition performance from Time 1 to Time 2, Ms = 4.0 versus 2.5; F(1, 72) = 45.3,
p < .01. There was also a decline over time for RMp, Ms = 5.5 versus 5.0; F(1, 72) =
10.7, p < .01. At both time intervals, pictures were remembered significantly better
than words: at Time 1, Ms = 5.5 versus 4.0; t(77) = 9.3, p < .01; at Time 2, Ms = 5.0
versus 2.5; t(75) = 13.2, p < .01. No other effects for group, gender, or interactions
emerged.

Posttest Questionnaire
Overall, there was no evidence to suggest that explicit contamination affected im-
plicit memory performance. In response to the first open-ended question regarding
the nature of the study (“Why do you think we saw all those words and pictures at
the beginning?”), 33 of 78 children simply stated that they “didn’t know” or “had
no idea” (43% were in the ADHD group vs. 42% non-ADHD); another 33 children
thought it was for reading comprehension, spelling, or speech (33% ADHD vs.
48% non-ADHD); only 8 children thought that the words and pictures from the
study phase might have to be memorized (13% ADHD vs. 8% non-ADHD); the re-
maining 4 children gave other answers or did not respond (10% ADHD vs. 2%
non-ADHD). Moreover, when children were asked if they thought the reason for
the study was to check their eyesight, 31 of 78 thought that the test might have
been—or actually was—for this purpose (43% ADHD vs. 38% non-ADHD).
For the second open-ended question and follow-up question (“Did you think
[the words and pictures we saw at the beginning] helped you with any of the games
we played or not? Which ones?”), variables were coded to reflect the perceived re-
lation between the study phase and each of the implicit tests at Time 1 (WSC,
CEG, and PFI). For example, if a child responded to the questions with, “Yes—the
 IMPLICIT MEMORY IN ADHD 795

TABLE 4
Correlations of Implicit Measures With Explicit
Contamination and Intercorrelations Among
Explicit Contamination Measures

Explicit Contamination

Measure WSC–x CEG–x PFI–x

WSCw .16 .09 .33**

CEGw –.10 –.13 .03
CEGp –.09 –.08 –.04
PFIp –.10 –.15 –.13
WSC–x — .59** .37**
CEG–x — — .24*
PFI–x — — —

Note. The “x” suffix indicates reported explicit contamination on the

given test. WSC = word stem completion; CEG = category exemplar genera-
tion; PFI = picture fragment identification; w = word; p = picture.
*p < .05. **p < .01.

one where I had to fill in the picture,” only PFI was coded to reflect explicit con-
tamination; if a child responded with, “Yes, all of them,” or if he or she was not sure
which specific tests helped, all implicit tests were counted. Table 4 shows that all
of the intercorrelations among explicit contamination measures were significant—
implying that those who believed that the study phase was helpful for one implicit
test tended to believe it of all the implicit tests. The only significant relation to
emerge between explicit contamination and actual implicit memory performance
was nonsensical—that is, those who thought the study phase helped them with
their performance on PFI did better on WSC. Thus, the overall pattern of results
suggests that the implicit memory measures were free from explicit contamination
effects.

Additional Analyses: Conners’ ADHD Scales

and Confounding Influences
The ADHD and non-ADHD group comparisons made previously were based on
the original ADHD diagnosis identified through the school’s Health Concerns
List. Although this original ADHD diagnosis correlated moderately to strongly
with both CPRS and CTRS measures (see Table 2), we also sought to corroborate
these measures directly with memory outcomes, particularly in relation to the three
DSM–IV scales—Inattentive, Hyperactive-Impulsive, and ADHD Total. Although
neither the CPRS nor the CTRS offers a certain clinical diagnosis of ADHD sub-
types, they do provide a continuous index of behaviors uniquely related to inatten-
tion and hyperactivity as well as an overall “ADHD Total” score, thereby offering a
796 BURDEN AND MITCHELL

means for examining the severity of these behavioral deficits in relation to out-
come. These additional analyses were also intended to address the influence of five
potential confounds that posed a challenge for understanding the effect of ADHD:
LD; active medication for ADHD; the child’s potential comorbid anxiety problems
and oppositional behavior (according to CPRS and CTRS ratings); and intellectual
ability (Otis–Lennon Total). Due to the uncertain impact of gender in the previous
set of analyses, additional analyses were limited to boys only.
Of the 59 boys in the study, the CPRS was missing from 8 of the boys’ parents,
but only one of these boys had been identified with ADHD in the original group-
ings; the CTRS was missing from 2 boys’ teachers, one of whom had been identi-
fied with ADHD in the original groupings. Otis–Lennon scores were not available
for the 22 youngest children in the study—7 of these children were boys in the
ADHD group; 11 were boys in the non-ADHD group. Hierarchical linear regres-
sion analyses were conducted to examine boys’ overall CEG performance (the
composite average of word and picture priming) in relation to both CPRS and
CTRS DSM–IV scales (Table 5). Due to high intercorrelations among the DSM–IV
scales as well as the potential confounds, hierarchical linear analyses were con-
ducted separately for each confound in relation to each DSM–IV scale to combat
nullifying influences of multicollinearity.
Table 5 shows that among boys whose parents returned the CPRS forms (n =
51), four of the five potential confounds were significantly related to CEG at the
first step, as indicated by standardized beta (β1) and the proportion of variance (R2)
accounted for after inclusion of the confound. However, despite the significantly
poorer performance associated with LD, medication taken for ADHD, and higher
parent-rated oppositional behavior, all three of the DSM–IV scales (Inattention,
Hyperactivity, and ADHD Total) showed significant influences above and beyond
each of the confounds alone (i.e., significant ∆R2). Similarly, even though
Otis–Lennon Total score was associated with better CEG performance, the
DSM–IV scales contributed significantly more to variability in CEG performance.
Moreover, when the confound (β1) was entered at the second step simultaneously
with the DSM–IV scale (β2), the influence of the confound was rendered non-
significant in all but one instance—that is, LD remained a significant predictor of
CEG when entered with the Hyperactive scale, even though its magnitude was
considerably less (β1 = –.26 vs. β2 = –.49); by contrast, the DSM–IV scale always
remained a significant predictor (see Table 5).
A similar pattern emerged for the subset with CTRS data, although effects were
strongest for teacher-rated Inattention (Table 5). Again, four of the five confounds
appeared to have an impact on CEG performance. In contrast to parent ratings,
teacher-rated anxiety appeared to have a significant effect on CEG, whereas
teacher-rated oppositional behavior showed no effect. CTRS Inattention showed
an influence on CEG performance above and beyond the effect of the confounds,
often rendering the confounding influence nonsignificant (see Table 5). The
 TABLE 5
Hierarchical Linear Regression Results for Predictability of Conners’ Diagnostic and Statistical Manual of Mental Disorders
(4th ed.; DSM–IV) Scales on Boys’ CEG Performancea After Inclusion of Potential Confounds

Second Step (Conners DSM–IV Scale)

First Step Inattention Hyperactive ADHD Total

Confound 1 R2 1 2 R2 1 2 R2 1 2 R2 n

CPRSb
LD –.31* .10* –.15 –.59** .32** –.26* –.49** .24** –.19 –.58** .33** 51
Meds ADHD –.45** .20** –.10 –.57** .20** –.23 –.38* .10* –.09 –.57** .19** 51
CPRS Anxiety –.20 51
CPRS Oppositional Behavior –.36** .13** <.01 –.63** .27** .09 –.58** .14** .21 –.77** .28** 51
Otis–Lennon .34* .12* .12 –.62** .33** .23 –.38* .13* .15 –.56** .27** 36
CTRSc
LD –.28* .08* –.09 –.33* .08* –.27* –.04 <.01 –.19 –.20 .03 57
Meds ADHD –.40** .16** –.30* –.26* .06* –.40** –.04 <.01 –.35** –.17 .03 57
CPRS Anxiety –.33* .11* –.18 –.29 .06 –.33* –.03 .04 –.26 –.17 .02 57
CPRS Oppositional Behavior –.05 57
Otis–Lennon .37* .14* .13 –.45** .15** .36* –.04 .05 .24 –.26 .05 41

Note. Separate hierarchical linear regression analyses were conducted for each of the Conners DSM–IV scales: Inattentive, Hyperactive-Impulsive, and at-
tention deficit/hyperactivity disorder (ADHD) Total. β1 = (standardized beta) represents the association between the potential confound and category exemplar
generation (CEG) outcome at the first and second steps; R2 = represents the variation in CEG outcome accounted for by the confound at the first step; ∆R2 = is the
change in R2 (i.e., additional variation) after inclusion of the DSM–IV scale at the second step; β2 = represents the unique effect of the DSM–IV scale when en-
tered simultaneously with the confound. If the potential confound showed no relation to CEG outcome at the first step (p > .05), further analyses were not con-
ducted. CPRS = Conners Parent Rating Scale; LD = learning disability; CTRS = Conners Teacher Rating Scale.
aCEG average word and picture priming. bResults based only on CPRS data. cResults based only on CTRS data.

*p < .05. **p < .01.

797
798 BURDEN AND MITCHELL

ADHD Total scale showed a similar, albeit nonsignificant pattern; however, it was
also noteworthy that neither the confound nor the ADHD Total scale were signifi-
cant when entered simultaneously at the second step, except in relation to medica-
tion for ADHD, which remained a significant influence (β1 = –.35, second step).
The inclusion of the CTRS Hyperactive-Impulsive scale at the second step pro-
vided no significant evidence of additional influence on CEG performance. How-
ever, as noted previously in the Method section, teacher ratings of hyperactivity
were based on typical classroom behavior, which was likely to be influenced by the
effects of active medication (e.g., Ritalin) designed to reduce hyperactivity.

DISCUSSION

This study examined implicit and explicit memory functioning in children with
ADHD compared to children without ADHD. As expected, the repetition priming
method used to assess implicit memory was reliable across groups for the percep-
tual tests under conditions of same-format priming (i.e., word priming in WSC;
picture priming in PFI). Cross-format priming was not evident for either WSC or
PFI. These results are consistent with classification of WSC and PFI as perceptual
tasks (Blaxton, 1989; Toth, 2000), which typically show superiority for
same-format priming. Implicit memory on the perceptual tasks also remained sta-
ble across ages and the time interval, which is also consistent with previous re-
search in implicit memory development at this age (e.g., Naito, 1990). By contrast,
age-related improvements were found for explicit memory and there were overall
declines in explicit memory across the time interval. There was no evidence that
implicit memory performance was affected by test awareness or explicit contami-
nation, further validating the implicit memory measures. Both ADHD and
non-ADHD groups showed reliable priming on the perceptual implicit memory
tasks and there were no group differences on these tasks. These findings of intact
perceptual implicit memory are consistent with a recent study by Aloisi et al.
(2004), who found no ADHD-related deficits on a PFI task similar to the PFI task
used in this study. This study also extends findings of intact perceptual implicit
memory for pictures to a WSC task, providing further evidence that basic, rela-
tively automatic implicit memory processes appear to function normally in chil-
dren with ADHD.
Both ADHD and non-ADHD groups performed similarly on measures of ex-
plicit memory (RM and CCR), with the exception of poorer recognition for pic-
tures in the ADHD group at the 24-hr delay. This poorer memory performance by
the ADHD group at the longer delay is also consistent with Aloisi et al. (2004),
who found that children with ADHD showed poorer RM for pictures than a com-
parison group. In general, however, children in both groups showed comparable
explicit memory, demonstrating age-related improvements, expected picture supe-
 IMPLICIT MEMORY IN ADHD 799

riority effects, and declining performance across the 24-hr delay. We had predicted
that if differences in explicit memory were to occur between ADHD and
non-ADHD, they would have emerged on the more effortful task, CCR. However,
this effect was not evident.
The clearest evidence for a memory deficit associated with ADHD emerged for
the conceptual implicit memory test, CEG. Boys with ADHD showed no evidence
of priming for either words or pictures on CEG, in contrast to children in the
non-ADHD group and to girls with ADHD. Although post hoc analyses did reveal
reliable priming for the small subgroup of girls with ADHD (n = 6), future studies
with larger sample sizes may want to investigate this issue further. Gender differ-
ences on cognitive tasks are not uncommon in children with ADHD (e.g., Brown,
Madan-Swain, & Baldwin, 1991; Gaub & Carlson, 1997; Ott & Lyman, 1993) and
there is evidence that brain structures may be differentially adversely affected by
gender in ADHD (e.g., Ernst et al., 1994). Given the limited number of girls with
ADHD, however, it may be less prudent to conclude from this study that there are
gender differences in conceptual implicit memory than to conclude that only boys
with ADHD appear to be clearly affected on this task.
Factors such as age and intellectual ability also have been shown to affect con-
ceptual priming, despite no such effects on perceptual implicit tests (Komatsu et
al., 1996). Although the lack of CEG priming in the boys with ADHD has no other
basis for comparison, related findings of perceptual and conceptual distinctions
within a variety of clinical populations (e.g., Alzheimer’s disease, depression) may
offer some insight into this apparent deficit in ADHD. In particular, although the
various psychological and organic problems associated with these clinical groups
are not directly comparable to ADHD, they do share common generalized deficits
based on frontally mediated, complex, or effortful memory tasks. Although CEG
requires no conscious effort, the brain’s ability to structure information semanti-
cally when that information is meaningfully interrelated may vary as a function of
effort on an implicit level. In light of suggestions that conceptual priming is medi-
ated by frontal systems—which are thought to be affected by ADHD—the notion
of a “conceptual deficit” (see Blaxton, 1992) applied to ADHD may provide
grounds for testable hypotheses in future research.
Additional analyses from this study indicated that there were several potentially
confounding influences that might have contributed to the CEG deficit in boys
with ADHD. LD, active medication for ADHD, anxiety, and oppositional behavior
all corresponded with poorer CEG performance and intellectual ability
(Otis–Lennon) was positively associated with better CEG performance. Given that
all these confounds pose a challenge for understanding the effect of ADHD, addi-
tional analyses using the Conners parent and teacher ratings (CPRS and CTRS)
were conducted to measure the influence of ADHD-related behaviors in the pres-
ence of these confounding influences. For the CPRS, all three DSM–IV scales (In-
attention, Hyperactive-Impulsive, and ADHD Total) not only predicted perfor-
800 BURDEN AND MITCHELL

mance above and beyond the influence of the confounding variable, but the effects
of most of the confounds were nullified after the effect of the DSM–IV scale was
included simultaneously with the confound. This pattern of results indicates that
even though modest associations between the confounding variables and concep-
tual implicit memory performance were present, only the effect of ADHD appears
to have a truly significant impact on outcome.
A similar pattern emerged in relation to teacher ratings, with the most notable
exception being that the CTRS Hyperactive-Impulsive scale did not relate at all to
CEG after inclusion of confounds. This lack of a relation was not surprising, how-
ever, because teachers were asked to rate the child’s typical behavior in the class-
room—for children with ADHD, hyperactive behavior that is likely to be reported
by parents would be less apparent to teachers, who typically see the child on medi-
cation. Therefore, higher teacher ratings of hyperactive-impulsive behavior may
not be as apparent in children with ADHD. Indeed, overall teacher ratings for chil-
dren in the original ADHD group were relatively lower compared to parent ratings,
although parent and teacher ratings were still moderately to strongly correlated.
Nonetheless, teacher ratings of inattention were still predictive of CEG perfor-
mance above and beyond the influence of the confounding variables, suggesting
that inattention may be a better indicator of a cognitive deficit in CEG than hyper-
activity. Although not all studies have revealed effects of subtype on cognitive
tasks (Lockwood, Marcotte, & Stern, 2001; West, Houghton, Douglas, & Whiting,
2002), the inattentive subtype has been associated with academic underachieve-
ment (Marshall, Hynd, Handwerk, & Hall, 1997) and perceptual-motor speed and
processing deficits (Barkley, Grodzinsky, & DuPaul, 1992).
The influence of subtypes remains a question for future studies, but the con-
ceptual implicit memory deficit associated with ADHD—and inattention, in par-
ticular—is plausible based on previous literature showing effects of divided at-
tention on tasks similar to CEG. Specifically, perceptual and conceptual
dissociations of implicit memory have been found in healthy participants, who
show less or no conceptual priming under divided attention conditions, even
though perceptual priming remains intact (Mulligan, 1997). Although these di-
vided attention conditions are not directly comparable to the qualitative state of
an individual with ADHD, they do share some commonalities in terms of the
processing requirements that may be compromised. For instance, encoding un-
der divided attention conditions still allows for the processing of each stimulus,
but presumably less time is spent processing information when cognitive re-
sources are simultaneously required elsewhere (i.e., performing the divided at-
tention task). Children with ADHD are known to spend less time rehearsing and
attempting to retrieve items compared to their non-ADHD peers when proce-
dures are self-paced (O’Neill & Douglas, 1996). Even though encoding condi-
tions were equalized as much as possible in this study (e.g., keeping presentation
times consistent and the child on task), the amount of time devoted to the actual
 IMPLICIT MEMORY IN ADHD 801

processing of each stimulus may have differed by ADHD group. Anecdotally,

this seems plausible based on the observation that most children without ADHD
would sit still and watch closely for the next stimulus, whereas some children
with ADHD were more likely to name an item rapidly and then attempt to en-
gage in some distraction (e.g., finding out what was for lunch, tying a shoe) be-
fore the next trial. Craik and Kester (2000) argued that dividing attention does
not necessarily reduce elaboration or depth of processing, but other processes
such as consolidation are likely to be impaired when attention is divided. This
notion of impaired consolidation may also be relevant to ADHD, especially if
these children are indeed spending less time processing the material. Such a def-
icit may also explain why RM was poorer at the long delay in this study, even
though there were no differences between groups at the short delay.
The lack of conceptual priming in this study indicates that children with ADHD
did not benefit from the categorical, organizational structure inherent to the mate-
rial. Nonetheless, they were able to remember information in the explicit CCR test,
which differed from CEG only in the explicit task instructions. Children with
ADHD tend to have problems spontaneously generating organizational strategies
(e.g., Siklos & Kerns, 2004), but they will use them when made explicit (August,
1987; Cornoldi et al., 1999). If children with ADHD do not learn the material in a
conceptual manner as well as other children, they may rely instead on rote memori-
zation of facts devoid of semantic content. Previous studies have found that chil-
dren with ADHD tend to pay more attention to extraneous or irrelevant informa-
tion (e.g., Shaw & Brown, 1990, 1991), which may in turn reduce the conceptual
contribution to learning that results from focusing on information in a meaningful
way.
Experimental studies have shown that dramatic improvements in memory and
cognition can occur with medication treatment (e.g., Berman, Douglas, & Barr,
1999). Thus, it is possible that active medication effects were helpful to children
with ADHD in this study. Had cessation of medication been implemented, it may
have led to poorer overall memory performance in the ADHD group; however, the
active effects of medication in this study more likely gave the null hypothesis an
edge by increasing the difficulty of finding significant results. Thus, the finding of
a conceptual implicit memory deficit is even more striking in this context. More-
over, this deficit persisted above and beyond the influence of medication in the ad-
ditional analyses according to both CPRS and CTRS ratings. Although this study
lacks power to arrive at a decisive conclusion in this regard (i.e., only 6 children
with the original ADHD diagnosis were not on medication), these results suggest
that the conceptual implicit memory deficit is related more to ADHD than to medi-
cation use.
Replication of these results in a case-control design in which medication use
was temporarily interrupted would help to validate these findings. Other limita-
tions to this study include the lack of full clinical evaluations, which would have
802 BURDEN AND MITCHELL

been useful in characterizing the effect of subtypes as well as potential comorbid

disorders. A greater number of female participants would also help to understand if
these deficits are present only in boys with ADHD. Additional methods for assess-
ing conceptual implicit memory as well as an assessment of conceptual implicit
memory at longer delays would also be beneficial. Similarly, additional methods
of assessing effortful explicit memory tasks in relation to conceptual implicit
memory would provide support for frontally mediated deficits associated with
ADHD. Neuroimaging during performance on these and related tasks would offer
supportive evidence of differences in brain function that may be related to these
specific types of cognitive differences.
Despite limitations, this study characterizes a largely generalizable group of
children with ADHD—that is, those who have been identified as having ADHD
and are on medication for it on a daily basis. Ecological validity, which extends to
experimental setting and participant state, is absent in a laboratory or controlled
environment. Actual cognitive abilities can be altered dramatically in these situa-
tions (Neisser, 1976). This study provides a better understanding of how children
with ADHD perform in their everyday environment—an understanding that is cur-
rently lacking in ADHD research (see Safer, 2000). In this study, each participant
was tested individually in his or her school, with minimal disruption of daily rou-
tine. Therefore, the possibility that the experimental session was perceived as un-
usual or distressing was reduced. Indeed, many students thought it was a test of
their vocabulary or spelling abilities. Furthermore, because of the shared school
and classroom environment, ADHD and non-ADHD groups in this study were
more directly comparable than some clinic-referred studies that rely on an outside
comparison group without ADHD.
Tulving and Schacter (1990) noted: “Although priming is typically observed
only under carefully controlled experimental conditions, similar conditions fre-
quently occur naturally, outside the laboratory. It is reasonable to assume, there-
fore, that priming represents a ubiquitous occurrence in everyday life” (p. 302).
Given the amount of information with which school-aged children are presented
compared to the amount that can be remembered explicitly, implicit memory func-
tioning may have important implications for learning (see Anooshian, 1998, for re-
lated arguments). If, as our findings suggest, children with ADHD—or boys with
ADHD, at least—lack the conceptual priming ability evident in their peers with
ADHD, this type of implicit memory test may offer insight into a unique deficit in
organizational processing that operates outside of conscious awareness. Because
meaningful concepts are often implicitly embedded in information, children with
ADHD may benefit if these concepts can be revealed in a more explicit fashion.
Assessment batteries such as the Wide Range Assessment of Memory and
Learning have been useful in identifying explicit memory deficits associated with
ADHD (e.g., Mealer et al., 1996) and implicit memory assessments may also con-
tribute to a better understanding of ADHD.
 IMPLICIT MEMORY IN ADHD 803

ACKNOWLEDGMENTS

This research was part of a doctoral dissertation by Matthew J. Burden. Some of

these data were presented at the 74th annual meeting of the Midwest Psychological
Association, Chicago, IL, May 2002; and at the 17th Biennial Meeting of the Con-
ference on Human Development, Charlotte, NC, April 2002. This research was
supported, in part, by a dissertation fellowship from the Arthur J. Schmitt Founda-
tion; and by a grant to David B. Mitchell and the Loyola University Chicago
Center for Aging Studies from the Foley Family Foundation.
We gratefully acknowledge the assistance of Amy Woods, Nikki Osterman,
Luci Donnan, Peter Bruss, Catherine Haden, Anne Sutter, Grayson Holmbeck, and
Fred Bryant with various phases of this research; thanks also to Sandra Jacobson,
Joseph Jacobson, and Lisa Rapport for their suggested revisions on the article.

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