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ADHD and Executive Functioning: A Meta-Analytic Study on Shifting and Cognitive Flexibility
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Individuals with ADHD exhibit deficits in attention and hyperactivity/ impulsivity. ADHD also is referred to as a disorder of executive function (EF). Theories of EF suggest behavioral inhibition and working memory are often areas of impairment for people with ADHD; however, less is known with regards to set shifting. The present study aimed to address this question. Using meta-analysis, this study examined studies across three standard assessments of EF and specifically, set shifting. Studies with child, adolescent, and adult participants were investigated, and factors such as age, intelligence (IQ), study quality, and test version (card sorting) were explored as potential moderators of the relationship between ADHD and impairments in set shifting. Results indicated both performance measures and a rating scale of set shifting evidenced small to large effects that were statistically significant, suggesting these measures are sensitive to shifting impairments in people with ADHD. Meta-regression analysis indicated factors such as age and IQ, as well as test version in one instance, emerged as significant moderators of score variability, with additional variability in effects that remained unexplained. This suggests that, although these variables impact the degree of impairment as reflected by these measures, additional factors not accounted for may help to explain reasons for impairment. In summary, the relationship between poor shifting and ADHD is moderated by different factors. Within the current literature state, there is a paucity of studies targeting adolescents and adults with ADHD. In order to develop measures of shifting for use with these age groups, future studies may want to continue investigating deficits related to shifting.
Hinojosa, Ryan Heath (2019). ADHD and Executive Functioning: A Meta-Analytic Study on Shifting and Cognitive Flexibility. Doctoral dissertation, Texas A&M University. Available electronically from