Inattention Dimensions Research Articles

Systematic Review and Meta-analysis of the Relationship Between Exposure to Parental Substance Use and Attention-Deficit/Hyperactivity Disorder in Children.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsiveness. Among US children and adolescents aged 3-17 years, 9.4% have a diagnosis of ADHD. Previous research suggests possible links between parental substance use and ADHD among children. We conducted a systematic review and meta-analysis of 86 longitudinal or retrospective studies of prenatal or postnatal alcohol, tobacco, or other parental substance use and substance use disorders and childhood ADHD and its related behavioral dimensions of inattention and hyperactivity-impulsivity. Meta-analyses were grouped by drug class and pre- and postnatal periods with combined sample sizes ranging from 789 to 135,732. Prenatal exposure to alcohol or tobacco and parent substance use disorders were consistently and significantly associated with ADHD among children. Other parental drug use exposures resulted in inconsistent or non-significant findings. Prevention and treatment of parental substance use may have potential for impacts on childhood ADHD.

Dimensions of inattention: Cognitive, behavioral, and affective consequences.

Inattention to one's on-going task leads to well-documented cognitive, behavioral, and physiological consequences. At the same time, the reliable association between mind-wandering and negative mood has suggested that there are affective consequences to task inattention as well. We examined this potential relationship between inattention and mood in the following study. Six hundred and fifty-five participants completed self-report questionnaires related to inattentive thinking (i.e., attentional lapses, daydreaming, mindfulness, rumination, reflection, worry, postevent processing, inattentiveness, and counterfactual thinking), a questionnaire about depressive symptoms, and a questionnaire about anxiety symptoms. First, an exploratory factor analysis was conducted to identify potential underlying constructs of types of inattentive thinking. Using ordinary least squares extraction and Oblimin rotation, a three-factor model demonstrated suitable fit, broadly representing mind-wandering/inattentive consequences, repetitive negative thinking, and reflective/introspective thinking. Second, after eliminating measures that did not strongly load on any factor, structural equation modeling was conducted and found that the relationship between mind-wandering and depression was partially explained by repetitive negative thinking, whereas the relationship between mind-wandering and anxiety was fully explained by repetitive negative thinking. The present findings suggest that understanding how inattentive thoughts are interrelated not only influences mood and affect but also reveals important considerations of intentionality, executive functioning, and qualitative styles of these thoughts.

Associations of UPPS-P negative urgency and positive urgency with ADHD dimensions: Moderation by lack of premeditation and lack of perseverance in men and women

The study examined how dimensions of Whiteside and Lynam's (2003) UPPS-P model of impulsivity (lack of premeditation, lack of perseverance, negative urgency, and positive urgency) were associated directly and interactively with the attention-deficit/hyperactivity disorder (ADHD) dimensions of inattention and hyperactivity/impulsivity in men and women separately. A total of 550 adults (men = 147, women = 403), ages ranging from 18 to 65 years, from the general community completed questionnaires covering the study variables. For women, there was support for the additive model for the prediction of inattention, and both inattention and hyperactivity/impulsivity were predicted by lack of premeditation × positive urgency. For men, inattention was predicted by lack of premeditation × negative urgency, and lack of premeditation × positive urgency. In all instances, low levels of premeditation reduced the relationships between the urgency dimensions and ADHD dimensions. The theoretical and clinical implications of the findings are discussed.

Associations Between Dimensional Persistence of ADHD and Adult Sleep Quality in a Prospective Study of Girls

Objectives: We investigated the prospective association between (a) ADHD symptom dimensions, including their persistence and (b) adult sleep quality in a female sample, covarying adult depressive symptoms. Methods: Participants comprised four persistence groups (persisters, partials, desisters, and comparison) based on overall ADHD diagnosis and separate dimensions of inattention and hyperactivity/impulsivity (HI) in childhood, late adolescence, and early adulthood, featuring girls with (n = 140) and without (n = 88) carefully diagnosed ADHD. Results: Only persistence of inattention predicted lower adult sleep quality when covarying young-adult depression, which was also a significant predictor. When additionally covarying stimulant medication use in adulthood, inattention persistence lost significance, although depression maintained significance, with medication use predicting worse sleep quality. Conclusions: Persistence of inattentive (but not HI) symptoms was significantly related to adult sleep quality in the context of concurrent depression. Sleep quality is an important outcome for research on and treatment for ADHD.

Annual Research Review: Attention‐deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions

Attention-deficit/hyperactivity disorder (ADHD) - and its underlying behavioral dimensions of inattention and hyperactivity-impulsivity - have been understudied in females. We first cover the conceptual issues of prevalence, diagnostic practices, diversity, comorbidity, and causal factors, plus forces limiting awareness of ADHD in females. After a narrative review of cross-sectional and longitudinal findings, we conclude the following. (a) Girls meet diagnostic criteria for ADHD at just under half the rates of boys, a ratio that becomes much closer to equal by adulthood. (b) Girls and women with ADHD show a predominance of inattention and associated internalizing problems; boys and men display greater levels of hyperactive-impulsive symptoms and associated externalizing problems. (c) Sex differences in ADHD symptoms and related outcomes depend heavily on the clinical versus nonreferred nature of the samples under investigation. (d) Females with ADHD experience, on average, serious impairments, with a particularly heightened risk for problems in close relationships and engagement in self-harm. (e) Clinicians may overlook symptoms and impairments in females because of less overt (but still impairing) symptom manifestations in girls and women and their frequent adoption of compensatory strategies. Our review of predictors and mediators of adult outcomes highlights (a) the potential for heterotypically continuous pathways in females with childhood ADHD and (b) developmental progressions to self-harm, intimate partner violence, unplanned pregnancy, and comorbid psychopathology. Focusing on ADHD in females is necessary to characterize causal and maintaining mechanisms with accuracy and to foster responsive interventions, as highlighted in our closing list of clinical implications and research priorities.

T44. White Matter Tract Signatures of Emotional Lability and ADHD Traits in Young Children

40-50% of children with ADHD present with significant levels of emotional lability, which is associated with poorer outcomes. Characterizing how emotional lability interacts with the diagnostic dimensions of inattention and hyperactivity is therefore critical for effective treatment. As a starting point, we here interrogate the brain basis of this relationship in two white matter tracts crucial for attention and emotion processing: the superior longitudinal fasciculus (SLF) and the uncinate fasciculus (UF).

Which components of processing speed are affected in ADHD subtypes?

ABSTRACTThe term “processing speed” (PS) encompasses many components including perceptual, cognitive and output speed. Despite evidence for reduced PS in Attention-Deficit/Hyperactivity Disorder (ADHD), little is known about which component(s) is most impacted in ADHD, or how it may vary by subtypes. Participants included 151 children, ages 8–12 years, with ADHD Predominantly Inattentive Type, ADHD Combined Type and typically developing controls using DSM-IV criteria. All children completed four measures of processing speed: Symbol Search, Coding, Decision Speed, and simple reaction time. We found children with ADHD-PI and ADHD-C had slower perceptual and psychomotor/incidental learning speed than controls and that ADHD-PI had slower decision speed than controls. The subtypes did not differ on any of these measures. Mean reaction time was intact in ADHD. Hence, at a very basic output level, children with ADHD do not have impaired speed overall, but as task demands increase their processing speed becomes less efficient than controls’. Further, perceptual and psychomotor speed were related to inattention, and psychomotor speed/incidental learning was related to hyperactivity/impulsivity. Thus, inattention may contribute to less efficient performance and worse attention to detail on tasks with a higher perceptual and/or psychomotor load; whereas hyperactivity/impulsivity may affect psychomotor speed/incidental learning, possibly via greater inaccuracy and/or reduced learning efficiency. Decision speed was not related to either dimension. Results suggest that PS deficits are primarily linked to the inattention dimension of ADHD but not exclusively. Findings also suggest PS is not a singular process but rather a multifaceted system that is differentially impacted in ADHD.

El Desarrollo de la Estabilidad Emocional en Patología Dual: una Propuesta de Intervención Breve

The objective of the study was to achieve an emotional balance by learning the management and regulation of emotions in patients with dual pathology. The methodology was mixed (qualitative-quantitative). The total sample consisted of 27 voluntary participants divided into two groups: treatment (n = 21) and control (n = 6). Qualitative data were obtained through the Interview by Objectives, the Test of the Eyes and a final ad hoc survey. Regarding qualitative results, the treatment group improved in emotional regulation, achieving abstinence and therapeutic discharge. In quantitative terms, emotional deregulation (DERS) was evaluated at transversal and longitudinal levels. The results, when comparing the groups in the post-test, showed significant differences in favor of the treatment group in the dimension of inattention. At the longitudinal level, a difference was detected in the treatment group in the post-test with respect to the pre-test in the dimensions of inattention and uncontrol, and no difference was found in the control group. The conclusion of the study indicates the improvement of comprehension of emotions together with an adequate coping of negative experiences on the part of participants in the treatment group.

The role of inattention and hyperactivity/impulsivity in the fine motor coordination in children with ADHD

ObjectiveDeficits in fine motor coordination have been suggested to be associated with Attention-Deficit/Hyperactivity Disorder (ADHD). However, despite the negative impact of poor fine motor skills on academic achievement, researchers have paid little attention to this problem. The aim of this study was to explore the relationship between ADHD dimensions and fine motor performance. MethodParticipants were 43 children with a diagnosis of ADHD aged between 7 and 14 years (M=9.61; 81% male) and 42 typically developing (TP) children in the same age range (M=10.76; 75.2% male). ResultsChildren with ADHD performed worse than TP on all tasks (δFine_motor_tasks, −0.19 to −0.44). After controlling for age and ADHD-HY (hyperactivity/impulsivity), higher scores on ADHD-IN (inattentiveness) predicted a larger number of mistakes among all psychomotricity tasks and conditions (β 0.39–0.58, ps<0.05). ConclusionThe ADHD group showed poorer fine motor performance than controls across all fine motor coordination tasks. However, lower performance (more mistakes), was related to the inattention dimension but not to the hyperactivity/impulsivity dimensions. Authors recommend including training and enhancement of the fine motor skills for more comprehensive ADHD treatment.

Evaluating the Hierarchical Structure of ADHD Symptoms and Invariance Across Age and Gender

The bifactor model of attention-deficit/hyperactivity disorder (ADHD) has been extensively explored, yet the tendency of the bifactor model to overfit data necessitates investigation of alternative, more parsimonious models, such as a modified bifactor structure. The present study used item response theory to compare unidimensional, correlated factors, bifactor, and modified bifactor models of ADHD symptoms in a clinical sample of youth ( N = 1,612) and examined differential item functioning (DIF) by age (<11 and ≥11 years) and gender. Results suggested that two restricted bifactor models showed superior fit compared with alternative models, and support strong general and inattention dimensions, with unreliable hyperactivity and impulsivity dimensions. No DIF was found across gender or age. The present study confirms that the general dimension (i.e., inhibition) and one specific dimension (i.e., sustained attention) represent distinct variability in ADHD symptoms that may improve prediction of symptom persistence, treatment response, or functional outcomes.

Relationship of impulsivity with severity of ADHD symptoms while controlling the effects of anxiety and depression in a sample of inpatients with alcohol use disorder

ObjectiveThe aim of the present study was to evaluate relationship of impulsivity with severity of ADHD symptoms while controlling the effects of anxiety and depression in a sample of inpatients with alcohol use disorder.MethodParticipants included 190 inpatients with alcohol use disorder. Participants were evaluated with the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Short Form Barratt Impulsiveness Scale (BIS-11-SF) and the Adult ADHD Self-Report Scale (ASRS).ResultsImpulsivity predicted both severity of ADHD symptoms and inattentive and hyperactive/impulsive dimensions, even after controlling the effects of depression and anxiety in linear regression models. Types of negative affect that predicted dimensions of ADHD differed; similar with severity of ADHD symptoms, depression and trait anxiety also predicted inattentive dimension, whereas trait and state anxiety predicted hyperactive/impulsive dimension.ConclusionImpulsivity is related with severity of ADHD symptoms and dimensions of ADHD although negative affect that is related with dimensions may differ.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Associations between ADHD symptoms and smoking outcome expectancies in a non-clinical sample of daily cigarette smokers.

Smoking outcome expectancies for positive reinforcement (PR: beliefs that smoking produces desirable outcomes) and negative reinforcement (NR: beliefs that smoking alleviates negative affect) are modifiable cognitive manifestations of affect-mediated smoking motivation. Based on prior data and theory, we hypothesized that NR and PR expectancies are associated with ADHD symptom levels in a non-clinical sample of cigarette smokers. (Am J Addict 2016; XX:XX -XX) METHODS: Daily cigarette smokers (N = 256) completed self-report measures of ADHD symptoms and smoking outcome expectancies. Cross-sectional associations of overall ADHD symptomatology and the ADHD symptom dimensions of inattention (IN: difficulty concentrating and distractibility) and hyperactivity impulsivity (HI: poor inhibitory control and motor activity restlessness) with PR and NR smoking outcome expectancies were examined. Higher levels of overall, IN and HI ADHD symptoms were positively associated with NR smoking expectancies after statistically controlling for anxiety, depression, alcohol/drug use problems, nicotine dependence, and other smoking expectancies. Although neither HI nor IN symptom dimensions exhibited empirically unique relations to NR expectancies over and above one another, the collective variance across IN and HI was associated with NR expectancies. PR expectancies were not associated with ADHD symptoms. Although PR and NR expectancies may be important etiological influences in the overall population of smokers, NR outcome expectancies appear to be disproportionately expressed in smokers with elevated ADHD symptoms. Cognitive manifestations of NR motivation, which may be modifiable via intervention, are prominent in smokers with elevated ADHD symptoms. Beliefs that smoking alleviates negative affect may underlie ADHD-smoking comorbidity.

Attention Deficit/Hyperactivity Disorder (ADHD) Symptoms Predict Alcohol Expectancy Development

ABSTRACTObjective: Positive alcohol expectancies and attention deficit/hyperactivity disorder (ADHD) are independent risk factors for adolescent alcohol problems and substance use disorders. However, the association of early ADHD diagnostic status, as well as its separate dimensions of inattention and hyperactivity, with alcohol expectancies is essentially unknown. Method: At baseline (i.e., Wave 1), parents of 139 6- to 9-year-old children (71% male) with (N = 77; 55%) and without (N = 62; 45%) ADHD completed structured diagnostic interviews of child psychopathology. Approximately two years later (i.e., Wave 2), children completed a Memory Model-Based Expectancy Questionnaire (MMBEQ) to ascertain their positive and negative expectancies regarding alcohol use. All children were alcohol naïve at both baseline and follow-up assessments. Results: Controlling for age, sex, IQ, as well as the number of Wave 1 oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms, the number of baseline hyperactivity symptoms prospectively predicted more positive arousing (i.e., MMBEQ “wild and crazy” subscale) alcohol expectancies at Wave 2. No predictive association was observed for the number of Wave 1 inattention symptoms and alcohol expectancies. Conclusions: Childhood hyperactivity prospectively and positively predicted expectancies regarding the arousing properties of alcohol, independent of inattention and ODD/CD symptoms, as well as other key covariates. Even in the absence of explicit alcohol engagement, youths with elevated hyperactivity may benefit from targeted intervention given its association with more positive arousing alcohol expectancies.

Internal and External Validity of Sluggish Cognitive Tempo and ADHD Inattention Dimensions with Teacher Ratings of Nepali Children.

The objective was to evaluate the validity of sluggish cognitive tempo (SCT) and ADHD-inattention (IN) symptoms in children from Nepal. Teachers rated SCT, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, social impairment, and peer rejection dimensions in 366 children (50% girls) in first through sixth grades (M age = 9.35, SD age = 1.96) on two separate occasions separated by 4-weeks. Seven of the eight SCT symptoms and all nine ADHD-IN symptoms showed convergent validity (substantial loadings on their respective factors) and discriminant validity (higher loadings on their respective factor than the alternative factor) at both time-points. Across all three separate analyses (assessment 1, assessment 2, and from assessment 1 to assessment 2), higher SCT scores were associated with lower ADHD-HI scores and higher depression, academic impairment, and social impairment scores after controlling for ADHD-IN while higher ADHD-IN scores were associated with higher ADHD-HI, ODD, academic impairment, and peer rejection scores after controlling for SCT. Also, as hypothesized, SCT scores were not related to ODD scores after controlling for ADHD-IN. The study provides the first evidence for the internal and external validity of the SCT dimension relative to the ADHD-IN dimension with teacher ratings of children from Nepal, thereby increasing the validity of the SCT construct beyond North America, Western Europe, South America, and South Korea.

Dopamine receptor DRD4 gene and stressful life events in persistent attention deficit hyperactivity disorder.

We performed a case-control association study in persistent ADHD considering eight candidate genes (DRD4, DAT1/SLC6A3, COMT, ADRA2A, CES1, CYP2D6, LPHN3, and OPRM1) and found additional evidence for the involvement of the Dup 120bp and VNTR 48bp functional variants within the dopamine receptor DRD4 gene in the etiology of adult ADHD. We subsequently investigated the interaction of stressful life events with these two DRD4 polymorphisms, and the impact of such events on the severity of ADHD symptomatology. The gene-by-environment analysis revealed an independent effect of stressful experiences on the severity of persistent ADHD, and a gene-by-environment interaction on the inattentive dimension of the disorder, where non carriers of the Dup 120bp (L) - VNTR 48bp (7R) haplotype were more sensitive to environmental adversity than carriers. These results are in agreement with previous works reporting a relationship between DRD4 and the effect of adverse experiences, which may explain the discordant findings in previous genetic studies and strengthen the importance of gene-by-environment interactions on the severity of ADHD. © 2015 Wiley Periodicals, Inc.

Telomere length is highly inherited and associated with hyperactivity-impulsivity in children with attention deficit/hyperactivity disorder.

Telomere length (TL) is highly heritable, and a shorter telomere at birth may increase the risk of age-related problems. Additionally, a shorter TL may represent a biomarker of chronic stress and has been associated with psychiatric disorders. However, no study has explored whether there is an association between TL and the symptoms of one of the most common neurodevelopmental disorders in childhood: Attention Deficit/Hyperactive Disorder (ADHD). We evaluated 61 (range, 6–16 years) ADHD children and their parents between 2012 and 2014. TL was measured with a quantitative polymerase chain reaction method with telomere signal normalized to the signal from a single copy gene (36B4) to generate a T/S ratio. Family data was processed through a generalized estimated equations (GEE) model to determine the effect of parental TL on children TL. Inattentive and hyperactive-impulsive symptoms were also evaluated in relation to TL. For the first time, we found general heritability to be the major mechanism explaining interindividual TL variation in ADHD (father-child: 95% CI = 0.35/0.91, p < 0.001; mother-child: 95% CI = 0.38/0.74, p < 0.001). The hyperactive-impulsive dimension of ADHD was related with children’s TL (r = −339, p = 0.008) and maternal TL (r = −264, p = 0.047), but not with paternal TL (p > 0.05). The ADHD inattentive dimension was not significant associated with TL in this study (p > 0.05). TL was shown to be a potential biomarker of the ADHD symptoms burden in families affected by this neurodevelopmental disorder. However, it is crucial that future studies investigating the rate of telomere attrition in relation to psychiatric problems to consider the strong determination of TL at birth by inheritance.

Le neurofeedback dans le trouble déficit de l’attention/hyperactivité de l’enfant est-il efficace ? Depuis les études rigoureuses jusqu’aux bonnes pratiques cliniques

BackgroundNeurofeedback, based on the concept of creating a retroactive psychophysiological loop, has advantages compared with other cognitive therapeutic techniques in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). However, although this technique has been used for almost 20years in ADHD, the level of evidence for its efficacy remains debated. This debate has recently been brought into focus in the literature following a published meta-analysis. AimsThis article aims to review and classify existing literature on the efficacy of neurofeedback in ADHD. MethodsPublications were identified through a literature search of the electronic database PubMed using the Medical Subject Headings (Mesh) terms “Neurofeedback” and “Attention-Deficit/Hyperactivity Disorder”. All relevant papers published in English or French were reviewed by the authors. These were separated into 2groups: published before and after 2011. ResultsPrior to 2011, studies are characterized by low sample size and are often non-randomized and uncontrolled. In addition these are most often performed by practitioners who participated in the development of the first neurofeedback equipment and who have electrophysiological expertise, essential for effective training during sessions. In 2009 Arns et al. published the first meta-analysis on the efficacy of neurofeedback in ADHD. They found a large effect size, 1.02 (0.84 to 1.21) and 0.94 (0.76 to 1.12) respectively for the inattention and impulsivity dimensions, and a moderate effect size of 0.71 (0.54 to 0.87) on the hyperactivity dimension. Improved inattention dimension was proportional to the number of sessions and maintained in randomized trials, which was not the case for the hyperactivity dimension. After 2011, studies are characterized by larger samples, and methodology including randomized, controlled trials and blinded assessments. In 2013, Sonuga-Barke et al. published the second meta-analysis on the efficacy of neurofeedback in ADHD (Am J Psych). They found a smaller effect size of 0.59 (0.31 to 0.87) compared to the first meta-analysis of 2009. The effectiveness of neurofeedback was not confirmed in studies with blinded assessment. The effect size was 0.29 (−0.02 to 0.61) (P=0.07; NS). However the effectiveness of the training during neurofeedback sessions in some of the included studies has been called into question. ConclusionMethodological issues are likely to have a large impact on results obtained in studies of neurofeedback. Thus, it is critical that future trials implement adequately randomized, controlled, blinded designs that do not compromise the quality of neurofeedback session itself.

Phenotypic and genetic associations between reading comprehension, decoding skills, and ADHD dimensions: evidence from two population-based studies.

The phenotypic and genetic associations between decoding skills and ADHD dimensions have been documented but less is known about the association with reading comprehension. The aim of the study is to document the phenotypic and genetic associations between reading comprehension and ADHD dimensions of inattention and hyperactivity/impulsivity in early schooling and compare them to those with decoding skills. Data were collected in two population-based samples of twins (Quebec Newborn Twin Study - QNTS) and singletons (Quebec Longitudinal Study of Child Development - QLSCD) totaling ≈ 2300 children. Reading was assessed with normed measures in second or third grade. Teachers assessed ADHD dimensions in kindergarten and first grade. Both decoding and reading comprehension were correlated with ADHD dimensions in a similar way: associations with inattention remained after controlling for the other ADHD dimension, behavior disorder symptoms and nonverbal abilities, whereas associations with hyperactivity/impulsivity did not. Genetic modeling showed that decoding and comprehension largely shared the same genetic etiology at this age and that their associations with inattention were mostly explained by shared genetic influences. Both reading comprehension and decoding are uniquely associated with inattention through a shared genetic etiology.

EEG neurofeedback treatments in children with ADHD: an updated meta-analysis of randomized controlled trials.

Objective: We undertook a meta-analysis of published Randomized Controlled Trials (RCT) with semi-active control and sham-NF groups to determine whether Electroencephalogram-neurofeedback (EEG-NF) significantly improves the overall symptoms, inattention and hyperactivity/impulsivity dimensions for probably unblinded assessment (parent assessment) and probably blinded assessment (teacher assessment) in children with Attention Deficit Hyperactivity Disorder (ADHD).Data sources: A systematic review identified independent studies that were eligible for inclusion in a random effects meta-analysis.Data extraction: Effect sizes for ADHD symptoms were expressed as standardized mean differences (SMD) with 95% confidence intervals.Results: Five identified studies met eligibility criteria, 263 patients with ADHD were included, 146 patients were trained with EEG-NF. On parent assessment (probably unblinded assessment), the overall ADHD score (SMD = −0.49 [−0.74, −0.24]), the inattention score (SMD = −0.46 [−0.76, −0.15]) and the hyperactivity/impulsivity score (SMD = −0.34 [−0.59, −0.09]) were significantly improved in patients receiving EEG-NF compared to controls. On teacher assessment (probably blinded assessment), only the inattention score was significantly improved in patients receiving EEG-NF compared to controls (SMD = −0.30 [−0.58, −0.03]).Conclusions: This meta-analysis of EEG-NF in children with ADHD highlights improvement in the inattention dimension of ADHD symptoms. Future investigations should pay greater attention to adequately blinded studies and EEG-NF protocols that carefully control the implementation and embedding of training.

ADHD inattentive symptoms mediate the relationship between intelligence and academic performance in children aged 6-14.

Fluid intelligence and the behavioral problems of attention-deficit/hyperactivity disorder (ADHD) are related to academic performance, but how this association occurs is unclear. This study aimed to assess mediation and moderation models that test possible pathways of influence between these factors. Sixty-two children with ADHD and 33 age-matched, typically developing students were evaluated with Raven's Colored Progressive Matrices and the spelling and arithmetic subtests of the Brazilian School Achievement Test. Dimensional ADHD symptomatology was reported by parents. Our findings suggest that fluid intelligence has a significant impact on academic tests through inattention. The inattentive dimension was the principal behavioral source of influence, also accounting for the association of hyperactive-impulsive manifestations with school achievement. This cognitive-to-behavioral influence path seems to be independent of diagnosis related group, and gender, but lower socioeconomic status might increase its strength. Fluid intelligence is a relevant factor in the influence of ADHD behavioral symptoms on academic performance, but its impact is indirect. Therefore, early identification of both fluid intelligence and inattentive symptoms is of the utmost importance to prevent impaired academic performance and future difficulties in functioning.