Validity of the executive function theory of attention-deficit/ hyperactivity disorder: A meta-analytic review

Erik G. Willcutt, Alysa E. Doyle, Joel T. Nigg, Stephen V. Faraone, Bruce F. Pennington

Research output: Contribution to journalReview articlepeer-review

2392 Scopus citations


One of the most prominent neuropsychologic theories of attention-deficit/ hyperactivity disorder (ADHD) suggests that its symptoms arise from a primary deficit in executive functions (EF), defined as neurocognitive processes that maintain an appropriate problem-solving set to attain a later goal. To examine the validity of the EF theory, we conducted a meta-analysis of 83 studies that administered EF measures to groups with ADHD (total N = 3734) and without ADHD (N = 2969). Groups with ADHD exhibited significant impairment on all EF tasks. Effect sizes for all measures fell in the medium range (.46-.69), but the strongest and most consistent effects were obtained on measures of response inhibition, vigilance, working memory, and planning. Weaknesses in EF were significant in both clinic-referred and community samples and were not explained by group differences in intelligence, academic achievement, or symptoms of other disorders. ADHD is associated with significant weaknesses in several key EF domains. However, moderate effect sizes and lack of universality of EF deficits among individuals with ADHD suggest that EF weaknesses are neither necessary nor sufficient to cause all cases of ADHD. Difficulties with EF appear to be one important component of the complex neuropsychology of ADHD.

Original languageEnglish (US)
Pages (from-to)1336-1346
Number of pages11
JournalBiological Psychiatry
Issue number11
StatePublished - Jun 1 2005
Externally publishedYes


  • Attention-deficit/hyperactivity disorder
  • Executive function
  • Meta-analysis
  • Neuropsychology
  • Subtypes

ASJC Scopus subject areas

  • Biological Psychiatry


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