Beyond the dual pathway model: Evidence for the dissociation of timing, inhibitory and delay-related impairments in Attention Deficit/Hyperactivity Disorder

Sonuga-Barke, Edmund, Bitsakou, Paraskevi and Thompson, Margaret (2010) Beyond the dual pathway model: Evidence for the dissociation of timing, inhibitory and delay-related impairments in Attention Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 49 (4), 345-355. (doi:10.1016/j.jaac.2009.12.018).

Abstract

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

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

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

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

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