Beyond the Dichotomy: Cognitive Proficiency and Executive Functioning Profiles in an ADHD Sample

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by difficulties in aspects of executive functioning such as inattention, hyperactivity, and impulsivity (American Psychiatric Association [APA], 2022). These challenges may impact learning and information retrieval, leading to variations in academic, vocational, and social skill development (APA, 2022). Precise assessment of these skills is crucial for understanding the diverse cognitive, behavioral, and emotional challenges associated with an ADHD diagnosis. Despite a global prevalence rate between 5-10%, no standardized assessment method has been established (Neprily et al., 2023). The development of digital tools like the NIH Toolbox Cognition Battery (NTCB) and Test of Variables of Attention (T.O.V.A.) offer enhanced accessibility and efficacy in early detection (Greenberg et al., 2007; Weintraub et al., 2013).The study evaluates select NTCB measures of executive functioning, assessing their convergent and discriminant validity alongside established neuropsychological tests. It also investigates whether the T.O.V.A. and NTCB can identify unique cognitive profiles in an ADHD sample, further evaluating sex- and age-based profile differences. Correlation analyses using SPSS (Version 28) revealed strong convergent and discriminant validity of the NTCB Flanker, Dimensional Change Card Sort, and Pattern Comparison tests, with variable discriminant validity on the List Sorting test. Latent profile analysis (LPA) was used to identify distinct profiles using NTCB and T.O.V.A. tests within a sample of 213 participants between the ages of 5 and 26 years diagnosed with ADHD. Analyses were performed using MPlus8 statistical software, with missing data being accounted for by using full information likelihood estimation (FIML). Model selections were based on the number of fit indices and criteria (Nylund et al., 2013). By adjusting unique combinations of subtests and scores from both measures, 2 to 3 distinct profiles emerged within the data, underscoring the heterogeneity and complexity of this clinical population. The data did not support sex-based performance differences; however, older cohorts demonstrated stronger NTCB working memory and processing speed performances. The results highlight the versatility of the NTCB and T.O.V.A. in identifying unique neurocognitive profiles. Future research should explore their efficacy in diagnosing ADHD within diverse medical and psychiatric cohorts, aligning with emerging neuronal circuit theories.