Do delay aversion and executive function deficits make distinct contributions to the functional impact of ADHD symptoms? A study of early academic skill deficits

Background: The present study examined the distinct properties of executive functioning in relation to ADHD symptoms, as well as functional outcomes associated with ADHD. In line with the dual-pathway model of ADHD, executive functioning and delay aversion were expected to show independent effects on ADHD symptoms. Furthermore, relations to early academic skills were examined, and it was hypothesized that the two processes of the dual-pathway model can be differentiated in terms of their effect on academic skill deficits, such that EF deficits, but not delay aversion, mediate the link between ADHD and academic functioning. Results: As hypothesized, both EF deficits and delay aversion were independently related to ADHD symptoms. However, when conducting separate analyses for the two ADHD symptom domains, only the effect of EF deficits was independently related to symptoms of inattention, whereas only the effect of delay aversion was independently related to symptoms of hyperactivity/impulsivity. The mediation analysis showed that EF deficits, but not delay aversion, act as a mediator in the relation between symptoms of inattention and both mathematics and language skills. In addition, there was also a significant direct effect of inattention on early academic skills. Conclusions: The findings of the present study are of importance for current models of heterogeneity in ADHD as they 1) provide further support for the notion that EF deficits and delay aversion are two possible pathways to ADHD, 2) add new interesting knowledge by showing that EF deficits and delay aversion can be differentiated in terms of their relations to the two ADHD symptom domains, and 3) indicate that the two processes of the dual-pathway model can also be differentiated in terms of their effect on functional impairments associated with ADHD.