Causal heterogeneity in attention-deficit/hyperactivity disorder: Do we need neuropsychologically impaired subtypes?

Joel T. Nigg, Erik G. Willcutt, Alysa E. Doyle, Edmund J.S. Sonuga-Barke

Research output: Contribution to journalReview article

554 Scopus citations

Abstract

Before assigning full etiologic validity to a psycopathologic disorder, disease theory suggests that a causal dysfunction in a mechanism within the affect individuals must be identified. Existing theories on attention-deficit/ hyperactivity disorder (ADHD) suggest such dysfunctions in cognitive, neuropsychological, or motivational processes in the child. To date, researchers have tested these theories by comparing groups with DSM-defined ADHD to children without ADHD. Using executive functioning as an illustration of an issue that exists across all such theories, this article describes substantial overlaps in the group performance data. Thus only a subgroup may have executive deficits. Noted are other supportive data suggesting multiple pathways to ADHD. The article explores implications and recommends that future theory and research give more consideration to the probability that only a subset of behaviorally defined children will have a deficit in a given neurocognitive mechanism believed to contribute to the disorder. Creation of a provisional set of criteria in DSM-V for defining an "executive deficit type" could stimulate research to validate the first etiologic subtype of ADHD and spur the development of more sophisticated causal models, which in the longer term may give clinicians ways to target and tailor treatments.

Original languageEnglish (US)
Pages (from-to)1224-1230
Number of pages7
JournalBiological Psychiatry
Volume57
Issue number11
DOIs
StatePublished - Jun 1 2005

Keywords

  • ADHD
  • DSM-V
  • Executive functions
  • Heterogeneity
  • Neuropsychology

ASJC Scopus subject areas

  • Biological Psychiatry

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