Executive Functions and Methylphenidate Response in Subtypes of Attention-Deficit/Hyperactivity Disorder

Background Oculomotor tasks are a well-established means of studying executive functions and frontal-striatal functioning in both nonhuman primates and humans. Attention-deficit/hyperactivity disorder (ADHD) is thought to implicate frontal-striatal circuitry. We used oculomotor tests to investigate executive functions and methylphenidate response in two subtypes of ADHD. Methods Subjects were boys, aged 11.5–14 years, with ADHD-combined (n = 10), ADHD-inattentive (n = 12), and control subjects (n = 10). Executive functions assessed were motor planning (tapped with predictive saccades), response inhibition (antisaccades), and task switching (saccades-antisaccades mixed). Results The ADHD-combined boys were impaired relative to control subjects in motor planning (p < .003) and response inhibition (p< .007) but not in task switching (p> .92). They were also significantly impaired relative to ADHD-inattentive boys, making fewer predictive saccades (p< .03) and having more subjects with antisaccade performance in the impaired range (p< .04). Methylphenidate significantly improved motor planning and response inhibition in both subtypes. Conclusions ADHD-combined but not ADHD-inattentive boys showed impairments on motor planning and response inhibition. These deficits might be mediated by brain structures implicated specifically in the hyperactive/impulsive symptoms. Methylphenidate improved oculomotor performance in both subtypes; thus, it was effective even when initial performance was not impaired.