CHILD NEUROPSYCHOLOGY, 2017

VOL. 23, NO. 3, 255–272

http://dx.doi.org/10.1080/09297049.2015.1105207

Working memory and behavioral inhibition in boys with

ADHD: An experimental examination of competing models
R. Matt Alderson, Connor H. G. Patros, Stephanie J. Tarle, Kristen L. Hudec,
Lisa J. Kasper and Sarah E. Lea
Department of Psychology, Oklahoma State University, Stillwater, OK, USA

ABSTRACT ARTICLE HISTORY

Working memory (WM) and behavioral inhibition impairments Received 23 June 2015
have garnered significant attention as candidate core features, Accepted 2 October 2015
endophenotypes, and/or associated neurocognitive deficits of Published online 13
November 2015
attention-deficit/hyperactivity disorder (ADHD). The relationship
between ADHD-related WM and inhibition deficits remains rela- KEYWORDS
tively unclear, however, with inferences about the constructs’ ADHD; working memory;
directional relationship stemming predominantly from correla- behavioral inhibition; execu-
tional research. The current study utilized a dual-task paradigm tive function; models
to experimentally examine the relationship between ADHD-related
WM and behavioral inhibition deficits. A total of 31 boys (15 ADHD
and 16 typically developing [TD]) aged 8–12 years completed WM
(1-back and 2-back), behavioral inhibition (stop-signal task [SST]),
and dual-condition (1-back/SST and 2-back/SST) experimental
tasks. Children with ADHD exhibited significant, large-magnitude
WM deficits for the 1-back condition but were not significantly
different from children in the TD group for the 2-back, 1-back/SST,
and 2-back/SST conditions. Children with ADHD also exhibited
significant inhibition deficits for the SST, 1-back/SST, and 2-back/
SST conditions, but the within-group effect was not significant.
The findings suggest that ADHD-related stop-signal demands are
upstream, or compete for, resources involved in controlled-
focused attention and/or other central executive (CE), WM
processes.

Within the last few decades, executive-function deficits commonly associated with atten-
tion-deficit/hyperactivity disorder (ADHD) have garnered extensive consideration as
either tertiary correlates (Sergeant, 2000) or central core features that underlie the
ADHD phenotype (Barkley, 1997; Rapport, Alderson, et. al., 2008; Sonuga-Barke,
2003). One executive function, behavioral inhibition—the process of withholding or
stopping a prepotent response (Schachar & Logan, 1990)—has received particular con-
sideration, perhaps due to the seemingly intuitive relationship between behavioral inhibi-
tion and core features of the disorder as defined in the Diagnostic and Statistical Manual
of Mental Disorders – Fifth Edition (DSM-V; American Psychiatric Association, 2013),
such as impulsivity and hyperactivity. Inhibition models of ADHD (Barkley, 1997;

CONTACT R. Matt Alderson Ph.D., matt.alderson@okstate.edu Associate Professor, Oklahoma State University,
Department of Psychology, 116 North Murray, Stillwater, Oklahoma 74078-3064, USA.
© 2015 Taylor & Francis
256 R. M. ALDERSON ET AL.

Sonuga-Barke, 2003) are derived from Gray and McNaughton’s (1982) theory of brain-
behavior processes, and more recently, Logan and Cowan’s (1984) race model, which
suggests response inhibition depends on whether a stop-process can overtake a go-process
when go- and stop-processes are activated in close temporal sequence. A slow reaction to a
stop-stimulus decreases the probability that the stop-process will overtake the go-process.
Consequently, the race model suggests that children with ADHD exhibit inhibitory deficits
because their reaction times for stopping a prepotent response, i.e., stop-signal reaction
times (SSRTs), are disproportionately slower than their reaction times to go (i.e., go
reaction times; Schachar, Forget-Dubois, Dionne, Boivin, & Robaey, 2011).
Measures of ADHD-related behavioral inhibition deficits most commonly utilize a dual-
task paradigm, wherein children establish a prepotent response by responding to a series of
go-stimuli, and withhold or stop their response when a stop-stimulus (e.g., auditory tone) is
introduced (Alderson, Rapport, & Kofler, 2007). Following Schachar and Logan’s (1990)
seminal study of ADHD-related inhibition deficits, the stop-signal task (SST) has become
the leading paradigm used to examine inhibition in ADHD, largely due to its ability to
examine Logan, Cowan, and Davis (1984) race model of inhibition, and more specifically,
to estimate covert reaction times to stop-stimuli (i.e., SSRT).
Meta-analytic reviews of SST performance by children and adults with ADHD have
uniformly reported significant, medium-magnitude, between-group effect size estimates
when compared to the performance of typically developing (TD) peers (Alderson et al.,
2007; Lijffijt, Kenemans, Verbaten, & van Engeland, 2005; Lipszyc & Schachar, 2010;
Oosterlaan, Logan, & Sergeant, 1998; Willcutt, Doyle, Nigg, Faraone, & Pennington,
2005). Considered in isolation, SSRT findings from these reviews appear to suggest the
presence of reliable ADHD-related inhibition deficits—and no doubt subsequent stu-
dies have cited these findings to support further examinations of ADHD-related disin-
hibition via the stop-signal paradigm (e.g., Berger, Alyagon, Hadaya, Atzaba-Poria, &
Auerbach, 2013; Pani et al., 2013). A closer examination of Alderson et al.’s (2007) and
Lijffijt et al.’s (2005) meta-analytic findings of between-group stop-signal delay (SSD)
effect sizes, however, raises questions about the validity of this interpretation.
Contemporary SST studies most often utilize dynamic SSDs (latency between the
presentation of go- and stop-stimuli) that increase or decrease after each stop-trial
depending on inhibitory success or failure, respectively, and ensure that children success-
fully inhibit on approximately 50% of trials (Alderson et al., 2007; Lijffijt et al., 2005;
Lipszyc & Schachar, 2010). Accordingly, a child’s mean SSD provides a direct measure of
their inhibition performance such that a relatively short mean SSD reflects poor inhibi-
tion, while a relatively long mean SSD reflects better inhibition (Alderson, Rapport,
Sarver, & Kofler, 2008). In contrast, the more commonly reported SSRT metric is an
unobservable-latent variable that must be estimated by subtracting a child’s SSD from the
mean of his or her go reaction time (MRT) to prepotent stimuli (i.e., SSRT = MRT−SSD;
for a full review of SSRT estimation methods, see Band, van der Molen, & Logan, 2003).
Both Alderson et al. (2007) and Lijffijt et al. (2005) reported non-significant between-
group SSD effects sizes, suggesting that the between-group variability in their estimated
SSRT effect sizes was predominantly due to basic attentional processes associated with
responding to go-stimuli (i.e., MRT and MRT variability), rather than disinhibition.
These findings were supported by a subsequent experimental investigation which
concluded that SST performance is largely reflective of controlled-focused attention
 CHILD NEUROPSYCHOLOGY 257

associated with the central executive (CE) component of working memory (WM;
Alderson et al., 2008). Notably, a more recent review failed to find significant correla-
tions between SSRT, MRT, and MRT variability effect sizes (Lipszyc & Schachar, 2010),
suggesting the independence of the underlying cognitive processes. However, definitive
conclusions are obscured due to the absence of reported SSD effect sizes. Moreover,
recent mediation-model and experimental SST studies have failed to support inhibition-
model (Barkley, 1997; Sonuga-Barke, 2003) predictions that inhibition deficits underlie
ADHD-related impulsivity (Raiker, Rapport, Kofler, & Sarver, 2012) and hyperactivity
(Alderson, Rapport, Kasper, Sarver, & Kofler, 2011). In both instances, deficits asso-
ciated with the CE component of WM, rather than inhibition, were evidenced as the
primary candidate to explain the characteristic ADHD features.
In contrast to the inhibition models of ADHD (Barkley, 1997; Sonuga-Barke, 2003),
Rapport et al.’s (2001) and Rapport, Kofler, Alderson, and Raiker (2008) functional
WM model of ADHD suggests that deficits of WM—an executive function involved in
the temporary storage, maintenance, and manipulation of information used to guide
behavior—underlie DSM-V-defined (American Psychiatric Association, 2013) core
features such as inattention, hyperactivity, and impulsivity, as well as unfavorable
secondary outcomes, such as academic, occupational, and social impairments.
Moreover, the centrality of WM in Rapport and colleagues’ model suggests that
performance on inhibition paradigms, such as the SST, is downstream of WM pro-
cesses, and particularly processes associated with the CE.
The CE, often conceptualized as the working component of WM, is an attentional
controller responsible for overseeing and coordinating the storage/rehearsal systems,
focusing attention, dividing attention among concurrent tasks, and protecting temporarily
stored information from competing external or internal distracting information (Baddeley,
2007; Engle, Kane, & Tuholski, 1999). Viewed within the context of the WM model of
ADHD (Rapport et al., 2001), SST performance depends on the CE’s ability to focus
attention on go- and stop-stimuli, divide attention between monitoring and updating
input from continuously presented go- and stop-stimuli, initiate a correct choice-response
to go-stimuli, stop or withhold a response following a stop-signal, and reduce interference
from potential internal and external distractions not associated with the SST.
To date, only a few studies have explicitly examined the relationship between behavioral
inhibition and WM processes in ADHD. Aggregating findings from previous correlational
examinations of children with the disorder yields a medium-magnitude correlation
(r = .43) between SST and WM performance (Alderson, Rapport, Hudec, Sarver, &
Kofler, 2010; Mullane & Corkum, 2007; Raiker et al., 2012), indicating significant shared
variability between the constructs. Even more, findings from bootstrapped-mediation
analyses suggest that deficits of WM, and particularly the CE, underlie the relatively slow
SSRTs exhibited by children with ADHD on the SST (Alderson et al., 2010), consistent with
predictions from the WM model of ADHD (Rapport, Alderson, et al., 2008).
Although Alderson et al.’s (2010) findings serve as a reasonable first step for
examining the complex relationship between WM and SST performance, the ability
of mediation models to determine the causal relationship between variables (e.g., WM
deficits cause poor SST performance) is limited (Green, Ha, & Bullock, 2010).
Experimentally-based concurrent-task paradigms, in contrast, are well suited to deter-
mining the directional relationship between cognitive constructs (Rohrer & Pashler,
258 R. M. ALDERSON ET AL.

2003). For example, a decline in inhibition performance during a dual task (e.g.,
simultaneous inhibition and WM tasks) relative to performance on a simple task
alone (i.e., an inhibition-only task) would reflect the inhibition resources that are
available after completing the WM task (O’Donnell & Eggemeier, 1986), and conse-
quently suggest that SST performance is downstream of WM processes.
The current study is the first to experimentally test the directional relationship between
WM and inhibition deficits in children with and without ADHD. Children with ADHD
and TD children completed SST, 1-back, and 2-back WM tasks and two dual tasks that
simultaneously presented an n-back task and an SST task (i.e., dual 1-back/SST and dual
2-back/SST). A priori, we hypothesized that a change in simple-task performance relative
to dual-task performance would indicate a bottleneck of shared resources. Moreover, a
comparison of WM and SST performance changes across simple-task to dual-task
conditions would allow for inferences about the directional relationship of the processes
needed to complete the tasks. For example, a decline in WM performance alongside
relatively unchanged SST performance during the dual-task conditions (1-back/SST and
2-back/SST) compared to the simple n-back conditions would suggest that the resources
needed to complete the WM task (n-back) are downstream of the resources needed to
complete the inhibition (SST) task. Conversely, worsening SST performance with rela-
tively stable WM performance during dual-task conditions would suggest SST perfor-
mance is downstream of demands associated with the WM task. Finally, an examination
of the interaction between group and condition (simple vs dual) would allow for tests of
specific ADHD models. For example, Barkley’s (1997) model predicts that children with
ADHD, relative to non-affected children, will exhibit a disproportionate decrease in WM
performance during the dual-task condition. In contrast, Rapport, Alderson, et al.’s
(2008) model suggests that children with ADHD, relative to non-affected children, will
exhibit a disproportionate decrease in inhibition performance across conditions.

Method
Participants
A total of 31 boys (15 ADHD and 16 TD) aged 8–12 years (M = 9.91, SD = 1.36) were
recruited by or referred to a university-based assessment clinic through local pediatri-
cians, community mental health clinics, school system personnel, or self-referral.
Children in the TD group were primarily referred to the clinic by parents who were
interested in learning more about their child’s cognitive and academic strengths and
weaknesses. In exchange for their child’s participation, all parents were provided with
feedback about their child’s performance, as well as a comprehensive psychoeducational
evaluation report. The study was approved by the University’s Institutional Review
Board prior to the onset of data collection, and all parents and children gave their
informed consent/assent before participating in the study.

Group assignment
All children underwent a comprehensive diagnostic procedure consistent with the gold
standard used to identify children with ADHD (Weiss, 2010). After gathering
 CHILD NEUROPSYCHOLOGY 259

developmental, medical, educational, and social background information from parents,

all children and their parents participated in a detailed, semi-structured clinical inter-
view using the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and
Lifetime Version (K-SADS-PL; Kaufman et al., 1997). All K-SADS-PL interviews were
supplemented with parent and teacher behavior ratings scales, including the Child
Behavior Checklist (CBCL; Achenbach & Rescorla, 2001), Teacher Report Form
(TRF; Achenbach & Rescorla, 2001), and Conners 3 – Parent & Teacher (C3P and
C3T; Conners, 2008) scales. These ratings scales have excellent psychometric properties
and are routinely used in clinical evaluations and research protocols (Achenbach, 1991;
Conners, 2008).
Children were included in the ADHD group if they met the following criteria: (1)
evidence of ADHD-combined presentation based on information gathered from the K-
SADS-PL semi-structured interview with parent and child; (2) parent ratings within the
clinical range on the DSM-ADHD scale of the CBCL or C3P; and (3) teacher ratings within
the clinical range on the DSM-ADHD scale of the TRF or C3T. The use of broadband and
narrowband ratings in conjunction with the either/or rating scale criteria allows for the
screening of comorbid clinical disorders in children and improves diagnostic sensitivity. A
total of 15 children were included in the ADHD group and 6 of these children met criteria
for comorbid oppositional defiant disorder (ODD), 2 met the criteria for a comorbid
elimination disorder, and 2 met criteria for a comorbid learning disorder (LD).1
Children were included in the TD group if they met the following criteria: (1) no
clinical disorder based on the parent and child K-SADS-PL interview; (2) normal
developmental history based on a structured interview with the parent; and (3) ratings
within the normal range on all DSM scales of the CBCL, TRF, C3P, and C3T. A total of
16 children were included in the TD group.2
Children that presented with (1) gross neurological, sensory, or motor impairment,
(2) psychosis, (3) history of a seizure disorder, or (4) a Wechsler Intelligence Scale for
Children – Fourth Edition (WISC-IV; Wechsler, 2003) Full Scale IQ (FSIQ) score of
less than 80 were excluded from the study. Children (n = 4) that were prescribed
psychostimulant medication prior to participation were required to discontinue use of
the medication 24 hours prior to research sessions.

Measures
Stop-Signal Task (SST)
The SST and administration instructions were identical to those described in Schachar,
Mota, Logan, Tannock, and Klim (2000). Go-stimuli were displayed for 1000 ms as
uppercase, green X and O letters positioned in the center of a 43 × 36 cm computer
screen. Both letters appeared with equal frequency throughout the experimental blocks.
A wireless response pad was used wherein the left button was used to respond to the
1
All primary analyses were completed a second time without the 2 participants with a comorbid LD. The pattern of
results did not change, so the results from the entire sample are provided.
2
Three participants in the TD group had scores above 1.5 SDs on the parent ratings of ODD, conduct disorder, and/or
inattention. In each case, follow-up interviews with parents indicated that the elevations reflected an isolated event
and the ratings were not characteristic of the child’s typical behavior. Further, the scores were not consistent with
teacher ratings, and there was no evidence of impairment.
260 R. M. ALDERSON ET AL.

Figure 1. Visual schematic of (a) the SST task, (b) the n-back tasks, and (c) dual n-back/SST tasks.
Note. The SST task requires participants to press the left or right button on a response pad when an
X or O stimulus appears, respectively. Participants are instructed to withhold the button press when
the stop-signal (tone) is heard. The n-back tasks require participants to verbally indicate if a red
letter is the same (“Yes”) or different (“No”) as the green letter presented n stimuli earlier in the
sequence. The dual n-back/SST task requires children to perform the n-back and SST tasks
simultaneously.

letter X, and the right button was used to respond to the letter O. Each go-stimulus was
preceded by a dot (i.e., fixation point) displayed in the center of the screen for 500 ms.
This fixation point served as an indicator that a go-stimulus was about to appear. A
1000 Hz auditory tone (i.e., a stop-signal) delivered through speakers was generated by
the computer and presented randomly on 25% of the experimental trials. SSDs—the
latency between the presentation of go- and stop-stimuli—were initially set at 250 ms,
but dynamically adjusted ±50 ms contingent on a child’s performance on the previous
stop-trial. Successfully inhibited stop-trials were followed by a 50 ms increase in SSD,
and unsuccessfully inhibited stop-trials were followed by a 50 ms decrease in SSD. All
children completed two practice blocks and eight consecutive experimental blocks of 32
trials (24 go-trials, 8 stop-trials). MRT, MRT variability, SSD, and SSRT served as
dependent variables. Figure 1a displays a visual schematic of the SST.

Working Memory (WM)

Two n-back tasks were used as a measure of WM (Ragland et al., 2002) and were nearly
identical to the SST described above, except that stop-signals were not presented, and 8
trials per block (64 total trials) were presented in red font to serve as n-back prompts.
 CHILD NEUROPSYCHOLOGY 261

Specifically, children were instructed to say “yes” if the red letter was the same as the
green letter presented n stimuli earlier in the sequence, and to say “no” if it was
different. Children completed separate 1-back and 2-back conditions, where the WM
load was manipulated by adjusting the size of n (i.e., the number of stimuli back in the
sequence). Each condition included two practice blocks followed by eight consecutive
experimental blocks. The total number of correct trials was used as a dependent variable
for both the 1-back and 2-back conditions. Figure 1b displays a visual schematic of the
WM task.

Dual-task
The dual task was identical to the SST described above, except that 8 trials per block (64
total trials) were presented in red font to concurrently serve as n-back prompts. Again,
children completed separate 1-back and 2-back conditions. Children were also
instructed to withhold responses upon hearing a 1000 Hz auditory tone (i.e., stop-
signal) that was generated by the computer and presented randomly on 25% of the
experimental trials. All children completed two practice blocks and eight consecutive
experimental blocks of 32 trials (i.e., 20 green-font go-trials, 4 green-font stop-trials, 4
red-font go-trials, and 4 red-font stop-trials) for each of the dual n-back/SST conditions
(n = 1 and n = 2). Accuracy of the n-back yes/no responses, MRT, MRT variability,
SSD, and SSRT were used as dependent variables. Figure 1c displays a visual schematic
of the dual n-back/SST condition.

Procedures
Each task was administered as part of a larger testing battery and children completed all
tasks while seated alone in an assessment room approximately 0.70 m from a computer
monitor. Children received brief breaks (of 2–3 minutes) following every task, and
longer breaks (of 10–15 minutes) after every two to three tasks to minimize fatigue.
Each child was administered five experimental conditions (SST, 1-back, 2-back, dual 1-
back/SST, and dual 2-back/SST) in counterbalanced order across the testing sessions to
control for order effects. Each experimental condition consisted of two practice blocks
and eight experimental blocks (each block consisting of 32 stimuli).

Results
Data screening
Power analysis
G*Power v3.0.5 (Faul, Erdfelder, Lang, & Buchner, 2007) was used a priori to compute
the sample size required for omnibus tests. To estimate the power needed to examine
WM and behavioral inhibition between groups and across conditions, Cohen’s d effect
sizes of .74 and .63 were used based on between-group phonological WM (Kasper,
Alderson, & Hudec, 2012) and SSRT (Alderson et al., 2007) effect sizes reported in
previous meta-analytic reviews, respectively. The power was set to .80 based on the
recommendation of Cohen (1992). For an effect size of .74, α = .05, power (1−β) = .80, 2
groups and 4 WM conditions (1-back, 2-back, dual 1-back/SST, and dual 2-back/SST),
262 R. M. ALDERSON ET AL.

12 total participants were needed for a repeated measures analysis of variance

(ANOVA) to detect an interaction between group and WM condition. For an effect
size of .63, α = .05, power (1−β) = .80, 2 groups and 3 inhibition conditions (SST, dual
1-back/SST, and dual 2-back/SST), 18 total participants were needed for a repeated
measures ANOVA to detect an interaction between group and inhibition condition.
The current study includes 31 participants, and thus has sufficient power.

Outliers
Independent and dependent variables were examined for univariate outliers using a
criterion of 3.29 standard deviations (SDs) above or below the group mean, correspond-
ing to a p-value of less than .001 (Tabachnik & Fidell, 2001). No outliers were identified.

Preliminary analyses
The sample consisted of 25 Caucasian (80.6%), 2 Hispanic (6.5%), 2 biracial (6.5%), 1
Asian (3.2%), and 1 Native American (3.2%) children. Independent samples t-tests
indicated no significant between-group differences for age (p = .45), FSIQ (p = .05), or
Hollingshead (1975) socioeconomic status (SES, p = .23) scores, and a chi-squared test
of independence indicated no between-group differences in race (p > .73). As expected,
scores on the CBCL (p < .001), TRF (p < .001), C3P (p < .001), and C3T (p < .001) were
significantly higher for the ADHD group relative to the TD group. Table 1 displays the
demographic information.

MRT and MRT variability

A group (ADHD, TD) by condition (SST, 1-back, 2-back, dual 1-back/SST, dual 2-back/
SST) mixed-model ANOVA was used to examine MRT across the WM and inhibition
conditions. Neither the main effect of group, F(1, 29) = 0.186, p = .669, η2partial = .01,
nor the interaction between group and condition, F(4, 116) = 0.894, p = .470,

Table 1. Sample demographic data.

ADHD (n = 15) TD (n = 16)
M (SD) M (SD) χ2 t
Racial Composition (% of group) 2.01
Caucasian 80.0 81.3
Hispanic 6.7 6.3
Asian 0 6.3
Native American 6.7 0
Biracial 6.7 6.3
Age in Years 9.75 (1.45) 10.05 (1.31) 0.59
WISC-IV: Full Scale IQ 98.53 (8.92) 107.75 (15.54) 2.01
Socioeconomic Statusa 46.79 (7.40) 51.44 (12.51) 1.26
CBCL – DSM-ADHDb 68.33 (7.78) 51.06 (2.02) −8.34*
TRF – DSM-ADHDb 66.80 (6.90) 51.31 (2.30) −8.27*
C3 Parent – ADHD Totalb 75.73 (13.73) 49.13 (9.07) −6.32*
C3 Teacher – ADHD Totalb 72.07 (12.79) 46.63 (6.17) −6.98*
Note. *p < .001; aScores are based on the Four Factor Index of Social Status (Hollingshead, 1975); bt-score values are
reported for this scale. ADHD = attention-deficit/hyperactivity disorder; C3 = Conners3; CBCL = Child Behavior
Checklist; TD = typically developing; TRF = Teacher’s Report Form; WISC-IV = Wechsler Intelligence Scale for Children
– Fourth Edition.
 CHILD NEUROPSYCHOLOGY 263

Table 2. Performance data for WM and behavioral inhibition conditions.

ADHD (n = 15) TD (n = 16)
M (SD) M (SD)
MRT
SST 589.86 (71.20) 598.64 (49.16)
1-back 562.95 (53.55) 554.19 (73.61)
2-back 580.17 (61.90) 572.55 (59.00)
Dual 1-back/SST 600.98 (69.14) 594.69 (68.42)
Dual 2-back/SST 607.25 (66.18) 578.60 (74.07)
SDRT
SST 155.67 (23.56) 140.74 (31.74)
1-back 163.62 (30.24) 133.23 (29.65)
2-back 165.92 (25.99) 154.18 (25.46)
Dual 1-back/SST 167.92 (26.84) 153.94 (22.12)
Dual 2-back/SST 174.62 (26.28) 149.59 (25.93)
WM Performance
1-back 35.47 (12.19) 47.56 (10.79)
2-back 27.20 (9.59) 32.69 (12.25)
Dual 1-back/SST 29.40 (10.99) 33.13 (10.86)
Dual 2-back/SST 22.20 (9.49) 24.69 (8.09)
BI Performance – SSRT
SST 376.94 (67.13) 339.36 (73.08)
Dual 1-back/SST 384.89 (74.85) 327.89 (78.15)
Dual 2-back/SST 395.79 (58.99) 337.34 (79.56)
BI Performance – SSD
SST 212.92 (51.89) 259.28 (49.61)
Dual 1-back/SST 216.09 (63.88) 266.80 (44.57)
Dual 2-back/SST 211.46 (62.79) 241.26 (52.05)
Note. ADHD = attention-deficit/hyperactivity disorder; BI = behavioral inhibition; MRT = mean
reaction time; SDRT = standard deviation of mean reaction time; SSD = stop-signal delay;
SSRT = stop-signal reaction time; SST = stop-signal task; TD = typically developing;
WM = working memory.

η2partial = .03, were significant. The within-group main effect, however, was significant, F
(4, 116) = 5.44, p < 0.001, η2partial = .16. Least significant difference (LSD) post hoc
analyses indicated that the groups exhibited faster MRTs during the 1-back condition
compared to all other conditions (all ps < .01), except the 2-back condition (p = .091).
The groups’ MRT during the 2-back condition was significantly faster relative to their
MRT during the 1-back/SST condition (p = .032), but not significantly different from
their performance during the other conditions (all ps > .05). Finally, the groups’ MRTs
during the SST, 1-back/SST, and 2-back/SST conditions were not significantly different
(all ps > .05). Table 2 displays the groups’ MRTs and standard deviations of the mean
reaction times (SDRTs) across conditions.
Next, a group (ADHD, TD) by condition (SST, 1-back, 2-back, dual 1-back/SST, dual
2-back/SST) mixed-model ANOVA was used to examine MRT variability (SDRT) across
the WM and inhibition conditions. Both the main effects of group, F(1, 29) = 5.12,
p = .031, η2partial = .15, and condition, F(4, 116) = 7.28, p < .001, η2partial = .20, were
significant. LSD post hoc analyses indicated that the groups exhibited less MRT variability
during the SST and 1-back conditions compared to all other conditions (all ps < .01), but
the difference between MRT variability across SST and 1-back conditions was not
significantly different (p = .96). In addition, MRT variability was not significantly different
across the 2-back, 1-back/SST, and 2-back/SST conditions. Finally, the interaction
between group and condition was not significant, F(4, 116) = 2.41, p = .053,
η2partial = .08. Table 2 displays the groups’ MRTs and SDRTs across conditions.
264 R. M. ALDERSON ET AL.

WM and dual-task comparisons

A group (ADHD, TD) by condition (1-back, 2-back, dual 1-back/SST, dual 2-back/SST)
mixed-model ANOVA examined performance differences across the WM and dual-task
conditions. The results indicate a significant interaction between WM condition and
group, F(3, 87) = 4.06, p = .01, η2partial = .12. Two post hoc repeated-measures ANOVAs
were subsequently completed to examine the effect of condition on each group’s WM
performance separately, and a significant within-group main effect was found for both
the TD, F(3, 45) = 50.22, p < .001, η2partial = .77, and ADHD, F(3, 42) = 10.95, p < .001,
η2partial = .44, groups. LSD post hoc analyses indicated that both the ADHD and TD
groups’ WM performance was significantly better on the 1-back condition relative to all
other conditions (all ps < .03). In addition, WM performance was not significantly
different across the 2-back condition and dual 1-back/SST condition for either the
ADHD (p = .34) or TD (p = .86) groups. Finally, both groups’ performance on the dual
2-back/stop-signal condition was the worst relative to all other conditions (all ps < .04).
Post hoc t-tests indicated that the TD group performed significantly better than the
ADHD group on the 1-back task, t(29) = 2.93, p = .007; however, the groups were not
significantly different across the other three conditions (all ps > .05). Figure 2 and
Table 2 display the groups’ WM performance across conditions.

Figure 2. Total correct responses across WM and dual task conditions.

Note. ADHD = attention-deficit/hyperactivity disorder; SSN1 = dual 1-back/SST; SSN2 = dual 2-back/
SST; TD = typically developing. Error bars represent standard errors.
 CHILD NEUROPSYCHOLOGY 265

Behavioral inhibition and dual-task comparisons

Two group (ADHD, TD) by condition (SST, dual 1-back/SST, dual 2-back/SST) mixed-
model ANOVAs were used to examine inhibitory performance (SSD and SSRT) across
behavioral inhibition conditions. The main effect of group was significant for both SSD,
F(1, 29) = 7.06, p = .013, η2partial = .20, and SSRT, F(1, 29) = 5.40, p = .027, η2partial = .16,
such that children in the ADHD group had significantly shorter SSDs and longer
SSRTs. The within-group main effects for SSD, F(2, 58) = 1.21, p = .305,
η2partial = .04, and SSRT, F(2, 58) = 0.402, p = .671, η2partial = .01, were not significant.
The interaction effects for SSD, F(2, 58) = 0.63, p = .536, η2partial = .02, and SSRT, F(2,
58) = .462, p = .633, η2partial = .02, were also not significant. Figure 3 and Table 2 display
the groups’ inhibition performance across conditions.

Discussion
Previous correlational studies have demonstrated a reliable, medium-magnitude rela-
tionship between behavioral inhibition and WM processes in children with ADHD
(Alderson et al., 2010; Mullane & Corkum, 2007; Raiker et al., 2012), while meta-
analytic (Alderson et al., 2007; Lijffijt et al., 2005) and mediation-model (Alderson et al.,
2010) studies suggest that ADHD-related behavioral inhibition deficits, as measured by
the SST, are downstream of deficits of controlled-focused attention associated with the
CE component of WM. The current study was the first to use experimental methodol-
ogy to test the relationship between behavioral inhibition and WM processes in
children with ADHD using a classic concurrent/dual-task procedure.

Figure 3. SSRT and SSD across behavioral inhibition and dual task conditions.
Note. ADHD = attention-deficit/hyperactivity disorder; SSD = stop-signal delay; SSN1 = 1-back/SST;
SSN2 = 2-back/SST; SSRT = stop-signal reaction time; TD = typically developing. Error bars represent
standard errors.
266 R. M. ALDERSON ET AL.

Potential between- and within-group differences in MRTs and SDRTs were exam-
ined as a first step. While children in the ADHD group, relative to TD children,
exhibited more variable choice reaction times overall, the MRTs of the children in
the ADHD group were not significantly slower. This finding was initially surprising due
to the profusion of previous studies which suggest that children with ADHD are
typically more variable (Kofler et al., 2013; Sjöwall, Roth, Lindqvist, & Thorell, 2013)
and slower (Huang-Pollock, Mikami, Pfiffner, & McBurnett, 2007) on reaction-time
tasks. A second look at Alderson et al.’s (2007) meta-analytic review of the SST,
however, suggests that significant between-group differences in MRT were only
reported in 50% of the included studies. Therefore, although the current study’s MRT
finding was unexpected in the context of more general ADHD reaction-time research
(Klotz, Johnson, Wu, Isaacs, & Gilbert, 2012), it is not extraordinary relative to
previously published SST studies. Furthermore, an examination of the performance
across conditions suggests that the groups’ MRTs were slowest during tasks that
included stop-signals, consistent with previous findings which suggest that children
slow their MRTs following stop-trials (Alderson et al., 2007).
The primary focus of the current study was to examine changes in WM and SST
performance across simple- and dual-task conditions. Overall, the ADHD group,
compared to the TD group, exhibited a large-magnitude WM deficit during the 1-
back condition, consistent with previous meta-analytic findings (Kasper et al., 2012).
Further, both groups exhibited a decrease in WM performance during the 2-back and
dual-task conditions, relative to the 1-back condition. The groups were not significantly
different, however, during the 2-back and dual n-back/SST conditions. These null
between-group findings may suggest that the increased CE demands during the 2-
back and dual-task conditions (i.e., the dividing of attention among concurrent tasks
and/or the protection of temporarily stored information from competing external or
internal distracting information; Baddeley, 2007) sufficiently overwhelmed the TD
group so that they performed similarly to the ADHD group. Alternatively, these
findings may suggest that the 2-back and dual conditions were simply too difficult for
this age group, as indicated by the groups’ performance being at or below chance levels.
Notably, these findings are consistent with previous studies that failed to detect
significant between-group (ADHD, TD) differences on (n ≥ 2)-back tasks (e.g., Valera
et al., 2010).
Potential within- and between-group differences in behavioral inhibition, as indi-
cated by SSRT and SSD, were subsequently examined across simple- and dual-task
conditions. Consistent with previous meta-analytic studies that have evidenced reliable
between-group differences in the SSRT metric (Alderson et al., 2007; Lijffijt et al., 2005),
the current study’s ADHD group, when compared to the TD group, exhibited slower
average reaction times to stop-stimuli (SSRT). Surprisingly, children with ADHD also
obtained shorter mean SSDs, indicating that they exhibited inhibition deficits relative to
children in the TD group. It is noted that the unexpected nature of this SSD finding is
not that children with ADHD exhibited inhibitory deficits, but rather that, of the few
experimental (Alderson et al., 2008, 2010; Gupta, Kar, & Srinivasan, 2010; Lampe et al.,
2007) and meta-analytic (Alderson et al., 2007; Lijffijt et al., 2005) studies of ADHD that
have previously reported the SSD metric, this is the first to find a significant between-
group difference.
 CHILD NEUROPSYCHOLOGY 267

Unlike our findings of worsening WM performance during dual-task conditions, the

examination of inhibitory performance across conditions did not reveal a significant
main effect, regardless of the examined inhibition metric (SSRT or SSD). Further, the
groups’ average performance-change effect size across conditions was exceptionally
small for both SSRT (d = 0.09) and SSD (d = 0.18), suggesting that the null finding is
not likely due to insufficient statistical power. It appears that the demands associated
with completing the n-back tasks did not interfere with the processes needed to inhibit
responses on the SST. Moreover, the differential effect of dual-task demands on the
groups’ SST and n-back performance suggests that processes associated with the
completion of the SST are upstream of processes associated with the completion of
the n-back tasks. Although these findings are consistent with predictions from inhibi-
tion models of ADHD (Barkley, 1997; Sonuga-Barke, 2003), they are relatively surpris-
ing as they contrast a growing body of literature which suggests that ADHD-related
inhibition deficits, as measured by the SST, are downstream of impairments of con-
trolled-focused attention and/or other CE WM processes (Alderson et al., 2007, 2008,
2010, 2011; Kofler et al., 2013; Lijffift et al., 2005; Raiker et al., 2012). Potential causes
for the equivocal findings across the current and previous studies warrants
consideration.
Methodological differences between the current and past studies may provide the
most parsimonious explanation for the discrepant findings. Specifically, findings
from extant studies that have examined the correlation between n-back tasks and
other measures of WM (e.g., simple and complex span tasks) have been relatively
equivocal. For example, Schmiedek, Hildebrandt, Lövdén, Wilhelm, and
Lindenberger (2013) demonstrated that n-back tasks loaded on a factor that
reflected CE-related updating processes, which in turn was strongly correlated
(r = .96) with complex span performance. In contrast, a recent meta-analytic review
revealed significant heterogeneity in the distribution of correlations between n-back
and simple span tasks, suggesting the tasks likely measure different aspects of WM
under some conditions (Redick & Lindsay, 2013). Notably, previous examinations of
the relationship between SST and WM performance have relied exclusively on span
tasks. Therefore, the current findings may suggest that the directional relationship
between WM and SST performance is variable and dependent on the type of WM
processes that are examined.
Alternatively, rather than treating the inhibition and WM constructs as though they are
discreet, as implied by both inhibition (Barkley, 1997) and WM (Rapport, Alderson, et al.,
2008) models of ADHD, it may be more useful to conceptualize inhibition as a part of
WM such that inhibition deficits reflect a more general deficit of the CE (Miyake et al.,
2000). This view is consistent with contemporary conceptualizations of WM that ascribe
inhibitory processes to executive attention (Shipstead, Redick, Hicks, & Engle, 2012).
Within this framework, inhibition processes involved in behaviors such as staying on-
task, staying seated, maintaining orientation to target stimuli, and limiting the access of
extraneous information to WM would be upstream of other WM processes such as mental
manipulation and storage/rehearsal of stimuli. Conversely, WM processes would be
upstream of inhibition-performance demands such as the maintenance of rules, deci-
sion-making, and choice-response selection. Admittedly, this explanation is somewhat
speculative since previous ADHD studies have only examined the CE as a unified
268 R. M. ALDERSON ET AL.

construct, and future studies are needed to better explicate this potentially complex
relationship between behavioral inhibition and a fractionated CE in children with ADHD.
Although the current study improves upon previous correlational examinations of
inhibition and WM processes by using experimental methodology, a few potential
limitations warrant consideration. First, the current study’s sample is relatively small,
and small-n studies are often at increased risk for Type II errors. However, our
sample size of 31 was nearly twice as large as the number of participants necessary to
detect significant effects, based on a-priori power analyses, and null effects were
accompanied by small effect sizes. Another consideration is that the current study
only included male children, which limits the extent to which the findings may
generalize to females with ADHD. Our decision to include only males was based
on previous findings which suggest that females with ADHD tend to exhibit smaller-
magnitude executive function deficits, particularly in respect to WM (Kasper et al.,
2012). The inclusion of females would have likely reduced the magnitude of our
current study’s effect sizes and consequently increased the probability of a Type II
error. Nevertheless, the current study is a first step and future studies that experi-
mentally examine the relationship between inhibition and WM in females with the
disorder are needed.
In closing, the current findings add to a growing body of literature aimed at
explicating the complex relationship between WM and inhibitory deficits in children
with ADHD. Further disentanglement of specific CE processes is expected to aid the
development and refinement of WM-based interventions that have thus far failed to
demonstrate meaningful far-transfer effects (Rapport, Orban, Kofler, & Friedman,
2013). The current findings also emphasize the need for future studies to report the
SSD metric. It is not clear why SSD is so infrequently reported, given that it is as
readily available as other commonly-reported SST metrics (i.e., MRT, MRT varia-
bility, and SSRT) and provides a concrete measure of inhibitory success. Reporting
the SSD metric in future studies will allow the field to effectively evaluate experi-
mentally-based SST findings and draw conclusions from meta-analytic examinations
that may contradict the null SSD effect size estimates reported in previous reviews
(Alderson et al., 2007; Lijffijt et al., 2005). Finally, future longitudinal studies that
examine the dynamic relationship between inhibition and WM are needed, as the
directional relationship between the constructs is expected to change with age (e.g.,
inhibition may be less upstream in older children).

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This work was supported by the Oklahoma Center for the Advancement of Science &
Technology [grant number HR11-034].
 CHILD NEUROPSYCHOLOGY 269

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