The Comparative Study of Executive Function between Children with ADHD and Healthy Children
Objectives : To study and compare the executive function between children with attention-deficit/
hyperactivity disorder (ADHD) and healthy children
Methods : The sample group is 20 children who were newly diagnosed as ADHD according to
DSM-5 diagnostic criteria by child and adolescent psychiatrists at psychiatric outpatient unit
Ramathibodi Hospital and 20 healthy children with sex, age and education level close to children
with ADHD. Executive functions were assessed by Delis-Kaplan executive function system
(D-KEFS) nonverbal which is composed of Trail making test, Tower test and Design fluency test.
Descriptive statistic were used to calculate frequency, percentage, mean and standard deviation.
Dependent t-test and Wilcoxon signed ranks test statistics were used to compare executive function
between children with ADHD and healthy children.
Results : Children with ADHD have lower executive function than healthy children in the following
areas: 1) Self-inhibition average score which was tested by Tower test from the Rule-Violation-
Per-Item Ratio (ADHD = 4.40 normal children = 10.60, p <.001) and Total Rule Violations
(ADHD = 17.75 normal children = 80.30, p <.001) 2) Cognitive Flexibility average score which
was tested by Design fluency test from the total set-loss designs element: score (ADHD = 8.05
Normal children = 11.35, p = .006), total repeated designs: scaled score (ADHD = 11.25 normal
children = 12.60, p = .006) and percent design accuracy score (ADHD = 5.60 normal children =
10.80, p <.001) and 3) Planning which was tested by tower test from the total achievement score
(ADHD = 8.90 normal children = 11.20, p = .008). While there is no difference in statistical
significant in both groups from the Trail making test.
Conclusion : Children with ADHD have lower executive function than healthy children in
self-inhibition, cognitive flexibility and planning by Tower test and Design fluency test. These tools
can differentiate ADHD children from normal children. So they are useful to use as assessment
tools to develop executive function rehabilitation programs for children with ADHD which will help
and prevent these children together with clinical care and reduce the impact in the long term.
Chaiudomsom K, Phahaphak P, Wattanawitkij P, Phahaphak P, editors. Psychiatry. Nanawitthaya printing depot; 2016
Witthirarak N, Wanwaek K, Wannarit K, Pugratayakami P, Phinantavech S, Ketman P, editors. Siriraj Psychiatry DSM-5. Bangkok: Prayunsanthai printing; 2015
Boon-yasidhi V. Attention deficit hyperactivity disorder: diagnosis and management. Journal of the Psychiatric Association of Thailand 2012; 57: 373-86
Seri P. Learning problems. In: Witthirarak N, Wanwaek K, Wannarit K, Pugratayakami P, Phinantavech S and Ketman P, editors. Siriraj psychiatry DSM-5. Bangkok: Prayoonsanthai printing. 2015: 313.
Krain AL, Castellanos FX. Brain development and ADHD. Clinical psychology review 2006; 26: 433-44.
Ozonoff S, Jensen J. Brief report: Specific executive function profiles in three neurode¬velopmental disorders. Journal of Autism and Developmental Disorder 1999; 29:171-7.
Brown TE. ADD/ADHD and Impaired Executive Function in Clinical Practice. Curr Psychiatry Rep 2008; 10: 407-11.Neuroscience and neuropsychology of ADHD 2009; 1: 37-41.
Lezak MD, Howieson DB, Loring DW. Neuropsychological assessment. 4th ed. Oxford University Press Inc; 2004
Willcutt EG, Doyle AE, Nigg T, Faraone SV, Pennington BF. Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biol Psychiatry 2005; 57: 1336-46.
Biederman J, Monuteaux MC, Doyle AE, Seidman LJ, Wilens TE, Christie FF, et al. Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. J Consult Clin Psychol 2004; 72: 757-66.
Holmes J, Gathercole SE, Place M, Alloway TP, Elliott JE, Hilton KA. The diagnostic utility of executive function assessments in the identification of ADHD in children. Child and Adolescent Mental Health 2010; 15: 37-43.
Wodka EL, Mostofsky SH, Prahme C, Larson JC, Loftis, C, Denckla MB, et al. Process examination of executive function in ADHD: sex and subtype effects. The Clinical Neuropsychologist 2007; 22: 826-841.
Diamond A. Executive functions. Annu Rev Psychol 2013; 64: 135-68.
Strauss E, Elisabeth MSS, Otfriep S. Executive Functions.In A compendium of neuropsycho¬logical test: administration, norms, and commentary. 3rded. Oxford university press; 2006.
Delis DC, Kaplan E, Kramer JH. Delis Kaplan D-KEFS executive function system examiner’s manual. US. The Psychological Corporation Press; 2001
Nakawiro D, Chansirikanjana S, Srisuwan P, Aebthaisong O, Sudsakon P, Vittayajuksu J, et al. Group-based training of executive function, attention, memory and visuospatialfunction (Team-V) in patients with mild neurocognitive disorder. Journal of the Psychiatric Association of Thailand 2017; 62: 337-48
Wodka EL, Loftis C, Mostofsky SH, Prahme C, Larson JC, Denckla MB, et al. Prediction of ADHD I boys and girls using the D-KEFS. Arch Clin Neuropsychol 2008; 23: 283-93.
Anderson P. Assessment and development of executive function (EF) during childhood. Child Neuropsychol 2002; 8: 71-82.
Goldstein S, Naglieri J A. editors. Handbook of executive functioning. New York: Springer Science Press; 2014