Executive functions as mediators of theory of mind performance in children with attention-deficit/Hyperactivity...

Executive functions (EF) and theory of mind (ToM) are frequently impaired in attention-deficit/hyperactivity disorder (ADHD). Due to their close neurocognitive relationship, it is important to determine the extent to which EF mediates ToM performance in this population. The present study analyzed the mediating role of EF in ToM among children diagnosed with ADHD. A clinical group of children with ADHD (n = 63) was compared to a group of typically developing peers (n = 63) matched by age and gender. All participants completed standardized measures of EF and ToM. Group differences and mediation models were examined. Results demonstrated that children with ADHD performed significantly lower than their peers in most EF domains and across all ToM tasks. Working memory and selective attention were the strongest predictors of ToM performance, accounting for 16.8% to 51.8% of the variance in different ToM components. Ten mediation models confirmed partial mediation, with indirect effects accounting for 15.8% to 37.8% of the total effect in most models. In some models, such as Perspective Taking and Second-Order Emotion Attribution, indirect effects exceeded 50%, indicating a more substantial role of EF. Nevertheless, a considerable portion of the effect remained unexplained by EF alone. These findings indicate that EF, particularly working memory and selective attention, play an important but not exclusive role in ToM performance in ADHD. This pattern supports a multidimensional understanding of ToM and emphasizes its relevance for neuropsychological assessment in ADHD.