Department of Psychology, Florida State University.
Center for Children and Families, Florida International University.
Neuropsychology. 2021 Nov;35(8):792-808. doi: 10.1037/neu0000769. Epub 2021 Sep 27.
Pediatric attention-deficit/hyperactivity disorder (ADHD) has been associated with impairments in executive functioning and academic writing skills. However, our understanding of the extent to which these children's writing difficulties are related to their underdeveloped executive functions-and whether this relation is attributable to specific executive functions-is limited.
A clinically-evaluated and carefully-phenotyped sample of 91 children ages 8-13 (M = 10.60, SD = 1.25; 37 girls) were administered multiple, counterbalanced tests of the three core executive functions (working memory, inhibitory control, set shifting), assessed for ADHD symptoms via multiple-informant reports, and completed standardized, norm-referenced testing of three core writing skills (written expression, spelling, writing fluency).
Bias-corrected, bootstrapped conditional effects modeling indicated that underdeveloped working memory exerted significant direct effects on all three writing skills, as well as indirect effects on written expression and spelling via the ADHD symptoms pathway (all 95% CIs exclude 0.0). In contrast, inhibitory control uniquely predicted spelling difficulties only, set shifting was not associated directly or indirectly with any assessed writing skill, and ADHD symptoms failed to uniquely predict writing skills after controlling for working memory. This pattern of results replicated across informants (parent vs. teacher ADHD symptom ratings), and was robust to control for age, sex, socioeconomic status (SES), majority/minority race/ethnicity status, intellectual functioning (IQ), decoding skills, language skills, and learning disability status.
These findings suggest multiple pathways to writing skill difficulties in children with ADHD, while suggesting that their overt behavioral symptoms may be less involved in their writing difficulties than their underlying neurocognitive vulnerabilities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
小儿注意缺陷/多动障碍（ADHD）与执行功能和学术写作技能受损有关。然而，我们对于这些孩子的写作困难与他们尚未发育完全的执行功能的关系程度，以及这种关系是否归因于特定的执行功能的理解是有限的。
对 91 名 8-13 岁（M=10.60，SD=1.25；37 名女孩）的儿童进行了临床评估和精心表型分析，他们接受了多项核心执行功能（工作记忆、抑制控制、转换灵活性）的测试，通过多来源报告评估 ADHD 症状，并完成了三项核心写作技能（书面表达、拼写、写作流畅性）的标准化、常模参照测试。
经过偏置修正、自举条件效应模型分析，表明发育不良的工作记忆对所有三种写作技能都有显著的直接影响，通过 ADHD 症状途径对书面表达和拼写也有间接影响（所有 95%置信区间都不包括 0.0）。相反，抑制控制仅能预测拼写困难，转换灵活性与任何评估的写作技能都没有直接或间接的关系，而 ADHD 症状在控制工作记忆后无法单独预测写作技能。这一结果模式在不同的信息来源（父母与教师 ADHD 症状评定）中得到了复制，并且在控制年龄、性别、社会经济地位（SES）、多数/少数种族/族裔地位、智力功能（IQ）、解码技能、语言技能和学习障碍状况后仍然稳健。
这些发现表明 ADHD 儿童的写作困难有多种途径，而他们的明显行为症状在其写作困难中的作用可能不如其潜在的神经认知脆弱性。
