Department of Psychology, University of Central Florida, Orlando, FL 32761, USA.
J Abnorm Child Psychol. 2012 Jul;40(5):699-713. doi: 10.1007/s10802-011-9607-2.
Impulsivity is a hallmark of two of the three DSM-IV ADHD subtypes and is associated with myriad adverse outcomes. Limited research, however, is available concerning the mechanisms and processes that contribute to impulsive responding by children with ADHD. The current study tested predictions from two competing models of ADHD-working memory (WM) and behavioral inhibition (BI)-to examine the extent to which ADHD-related impulsive responding was attributable to model-specific mechanisms and processes. Children with ADHD (n = 21) and typically developing children (n = 20) completed laboratory tasks that provided WM (domain-general central executive [CE], phonological/visuospatial storage/rehearsal) and BI indices (stop-signal reaction time [SSRT], stop-signal delay, mean reaction time). These indices were examined as potential mediators of ADHD-related impulsive responding on two objective and diverse laboratory tasks used commonly to assess impulsive responding (CPT: continuous performance test; VMTS: visual match-to-sample). Bias-corrected, bootstrapped mediation analyses revealed that CE processes significantly attenuated between-group impulsivity differences, such that the initial large-magnitude impulsivity differences were no longer significant on either task after accounting for ADHD-related CE deficits. In contrast, SSRT partially mediated ADHD-related impulsive responding on the CPT but not VMTS. This partial attenuation was no longer significant after accounting for shared variance between CE and SSRT; CE continued to attenuate the ADHD-impulsivity relationship after accounting for SSRT. These findings add to the growing literature implicating CE deficits in core ADHD behavioral and functional impairments, and suggest that cognitive interventions targeting CE rather than storage/rehearsal or BI processes may hold greater promise for alleviating ADHD-related impairments.
冲动性是 DSM-IV 中三种 ADHD 亚型的两个亚型的标志,与无数不良后果相关。然而,关于导致 ADHD 儿童冲动反应的机制和过程的研究有限。目前的研究测试了两种竞争的 ADHD 模型——工作记忆 (WM) 和行为抑制 (BI)——的预测,以检验 ADHD 相关冲动反应归因于特定模型机制和过程的程度。ADHD 儿童(n=21)和典型发育儿童(n=20)完成了实验室任务,提供了 WM(领域一般中央执行 [CE]、语音/视觉空间存储/复述)和 BI 指数(停止信号反应时间 [SSRT]、停止信号延迟、平均反应时间)。这些指数被用作两个常用的评估冲动反应的实验室任务(CPT:连续性能测试;VMTS:视觉匹配样本)上 ADHD 相关冲动反应的潜在中介。偏倚校正、自举中介分析显示,CE 过程显著减弱了组间冲动性差异,因此,在考虑到与 ADHD 相关的 CE 缺陷后,这两个任务上的初始大幅度冲动性差异不再显著。相比之下,SSRT 部分中介了 CPT 上的 ADHD 相关冲动反应,但不是 VMTS。在考虑到 CE 和 SSRT 之间的共享方差后,这种部分衰减不再显著;在考虑到 SSRT 后,CE 继续减弱 ADHD-冲动关系。这些发现增加了越来越多的文献,这些文献表明 CE 缺陷在核心 ADHD 行为和功能障碍中起作用,并表明针对 CE 而不是存储/复述或 BI 过程的认知干预可能更有希望缓解 ADHD 相关的损伤。