Cross-cultural variations in executive function impairments among children with attention deficit/hyperactivity...

Executive function (EF) impairments are heterogeneous in children with attention deficit/hyperactivity disorder (ADHD). Culture has a significant impact on EF development in typically developing (TD) children, yet its influence on EF impairments in those with ADHD remains understudied. This study aims to investigate the impact of cultural factors on EF impairments in children with ADHD through a cross-cultural comparison.

To ensure a robust sample size, the study initially recruited a large participant pool of 690 children from China and Australia. We applied similar diagnostic criteria and used propensity score matching to align clinical representation. This approach resulted in a final sample of 198 children aged 7-12, including 102 children diagnosed with ADHD and 96 TD peers. The same neuropsychological testing battery was used to assess EF in terms of working memory (WM), inhibitory control (IC), and set shifting.

Significant cultural effects were observed: Chinese children with ADHD showed lower performance in IC and WM compared to their TD peers, a pattern not seen in Australian children. A latent profile analysis revealed distinct EF profiles, highlighting a subgroup of Chinese children with severe EF impairments.

This study advances cross-cultural ADHD research on EF by using a robust methodology, including consistent diagnostic and testing procedures, propensity score matching, and person-centered analysis. Our findings suggest that high-EF-expectation environments may have a negative effect on EF in children with ADHD, which provides insight into the underlying contributors to heterogeneous EF and underscores the need for culturally tailored ADHD interventions.