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Cool and hot executive function in conduct-disordered adolescents with and without co-morbid attention deficit hyperactivity disorder: relationships with externalizing behaviours

  • M. Dolan (a1) (a2) and C. Lennox (a3)

An understanding of the exact nature of executive function (EF) deficits in conduct disorder (CD) remains elusive because of issues of co-morbidity with attention deficit hyperactivity disorder (ADHD).


Seventy-two adolescents with CD, 35 with CD + ADHD and 20 healthy controls (HCs) were assessed on a computerized battery of putative ‘cool’ and ‘hot’ EFs. Participants also completed the Child Behaviour Checklist (CBCL).


In the cool EF tasks such as planning, the CD + ADHD group in particular showed most notable impairments compared to HCs. This pattern was less evident for set shifting and behavioural inhibition but there were significant correlations between errors scores on these tasks and indices of externalizing behaviours on the CBCL across the sample. For hot EF tasks, all clinical groups performed worse than HCs on delay of gratification and poor performance was correlated with externalizing scores. Although there were no notable group differences on the punishment-based card-playing task, there were significant correlations between ultimate payout and externalizing behaviour across groups.


Overall, our findings highlight the fact that there may be more common than distinguishing neuropsychological underpinnings to these co-morbid disorders and that a dimensional symptom-based approach may be the way forward.

Corresponding author
*Address for correspondence: Professor M. Dolan, Centre for Forensic Behavioural Science, Monash University, 505 Hoddle Street, Clifton Hill, VIC 3068, Australia. (Email:
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Achenbach TM (1991). Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Department of Psychiatry, University of Vermont: Burlington, VT.
Ackerman PT, Anhalt JM, Dykman RA (1986). Arithmetic automatization failure in children with attention and reading disorders: associations and sequela. Journal of Learning Disabilities 19, 222232.
Arffa S, Lovell M, Podell K, Goldberg E (1998). Wisconsin Card Sorting Test performance in above average and superior school children: relationship to intelligence and age. Archives of Clinical Neuropsychology 13, 713720.
Barkley RA (1998). Attention-Deficit Hyperactivity Disorder, 2nd edn. Guilford Press: New York.
Barkley RA, Edwards G, Laneri M, Fletcher K, Metevia L (2001). Executive functioning, temporal discounting, and sense of time in adolescents with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). Journal of Abnormal Child Psychology 29, 541556.
Barnett R, Maruff P, Vance A, McStephen M, Costin J, Luk E (2009). Neurocognitive function in ADHD with and without comorbid disruptive behaviour disorders. Australian and New Zealand Journal of Psychiatry 43, 722730.
Bechara A, Damsio H, Tranel D, Demasio AR (1997). Deciding advantageously before knowing the advantageous strategy. Science 275, 12931295.
Biederman J, Petty CR, Clarke A, Lomedico A, Farone SV (2011). Predictors of persistent ADHD: an 11-year follow-up study. Journal of Psychiatric Research 45, 150155.
Clarke C, Prior M, Kinsella GJ (2000). Do executive function deficits differentiate between adolescents with ADHD and oppositional defiant/conduct disorder? A neuropsychological study using the Six Elements test and Hayling Sentence Completion test. Journal of Abnormal Child Psychology 28, 402414.
DeVito EE, Blackwell AD, Kent L, Ersche KD, Clark L, Salmond CH, Dezsery AM, Sahakian BJ (2008). The effects of methylphenidate on decision making in attention deficit hyperactivity disorder. Biological Psychiatry 64, 636639.
Dolan M (2012). The neuropsychology of prefrontal function in antisocial personality disordered offenders with varying degrees of psychopathy. Psychological Medicine 42, 17151725.
Dolan M, Park I (2002). The neuropsychology of antisocial personality disorder. Psychological Medicine 32, 417427.
Farrington DP (1989). Early predictors of adolescent aggression and adult violence. Violence and Victims 4, 79101.
Fray PJ, Robbins TW, Sahakian BJ (1997). Neuropsychiatric applications of CANTAB. International Journal of Geriatric Psychiatry 11, 329336.
Geurts HM, Verté S, Oosterlaan J, Roeyers H, Sergeant JA (2004). How specific are executive functioning deficits in attention deficit hyperactivity disorders and autism? Journal of Child Psychology and Psychiatry and Allied Disciplines 45, 836854.
Harrier LK, DeOrnellas K (2005). Performance of children diagnosed with ADHD on selected planning and reconstitution tests. Applied Neuropsychology 12, 106119.
Heaton RK (1981). A Manual for the Wisconsin Card Sorting Test. Psychological Assessment Resources: Odessa, FL.
Hobson CW, Scott S, Rubia K (2011). Investigation of cool and hot executive function in ODD/CD independently of ADHD. Journal of Child Psychology and Psychiatry 52, 10351043.
Hummer TA, Kronenberger WG, Wang Y, Dunn D, Mosier KM, Kalnin AJ, Mathews VP (2011). Executive functioning characteristics associated with ADHD comorbidity in adolescents with disruptive behavior disorders. Journal of Abnormal Child Psychology 39, 1119.
Hurt J, Naglieri JA (1992). Performance of delinquent and nondelinquent males on planning, attention, simultaneous, and successive cognitive processing tasks. Journal of Clinical Psychology 48, 120128.
Jensen PS, Hinshaw SP, Kraemer HC, Lenora N, Newcorn JH, Abikoff HB, March JS, Arnold LE, Cantwell DP, Conners CK, Elliott GR, Greenhill LL, Hechtman L, Hoza B, Pelham WE, Severe JB, Swanson JM, Wells KC, Wigal T, Vitiello B (2001). ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. Journal of the American Academy of Child and Adolescent Psychiatry 40, 147158.
Kaufman J, Birmaher B, Brent D, Rao U, Ryan N (1996). Schedule for Affective Disorders and Schizophrenia in School-Age Children – Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal of the Academy of Child and Adolescent Psychiatry 36, 980998.
Lahey BB, Loeber R, Burke JD, Applegate B (2005). Predicting future antisocial personality disorder in males from a clinical assessment in childhood. Journal of Consulting and Clinical Psychology 73, 389399.
Luegar RJ, Gill KJ (1990). Frontal-lobe cognitive dysfunction in conduct disorder adolescents. Journal of Clinical Psychology 46, 696706.
Mahone EM, Hagelthorn KM, Cutting LE, Schuerholz LJ, Pelletier SF, Rawlins C, Singer HS, Denckla MB (2002). Effects of IQ on executive function measures in children with ADHD. Child Neuropsychology 8, 5265.
Martinussen R, Hayden J, Hogg-Johnson S, Tannock R (2005). A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. Journal of the Academy of Child and Adolescent Psychiatry 44, 337384.
Moffitt TE, Henry B (1991). Neuropsychological studies of juvenile delinquency and violence: a review. In Neuropsychology of Aggression (ed. Miller J. S.), pp. 6791. Kluwer Academic Publishers: Norwell, MA.
Morgan AB, Lilienfeld SO (2000). A meta-analytic review of the relation between antisocial behavior and neuropsychological measures of executive function. Clinical Psychology Review 20, 113136.
Murphy KR, Barkley R, Bush T (2001). Executive functioning and olfactory identification in young adults with attention deficit hyperactivity disorder. Neuropsychology 15, 211220.
Newman JP, Kosson DS, Patterson CM (1992). Delay of gratification in psychopathic and nonpsychopathic offenders. Journal of Abnormal Psychology 101, 630636.
Newman JP, Patterson CM, Kosson DS (1987). Response perseveration in psychopaths. Journal of Abnormal Psychology 96, 145148.
Nigg JT, Carte ET, Hinshaw SP, Treuting JJ (1998). Neuropsychological correlates of childhood attention deficit hyperactivity disorder: explainable by comorbid disruptive behaviour or reading problems? Journal of Abnormal Psychology 107, 468480.
Oosterlaan J, Scheres A, Sergeant JA (2005). Which executive functioning deficits are associated with AD/HD, ODD/CD and comorbid AD/HD + ODD/CD? Journal of Abnormal Child Psychology 33, 6985.
Oosterlaan J, Sergeant JA (1998). Response inhibition and response re-engagement in attention-deficit-hyperactivity disorder, disruptive, anxious and normal children. Behavioral Brain Research 94, 3343.
Owen AM, Downes JJ, Sahakian BJ, Polkey CE, Robbins TW (1990). Planning and spatial working memory following frontal lobe lesions in man. Neuropsychologia 28, 10211034.
Pennington BF, Ozonoff S (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry 37, 5187.
Rogers RD, Blackshaw AJ, Middleton HC, Matthews K, Hawtin K, Crowley C, Hopwood A, Wallace C, Deakin JFW, Sahakian BJ, Robbins TW (1999). Tryptophan depletion impairs stimulus-reward learning while methylphenidate disrupts attentional control in healthy young adults: implications for the monoaminergic basis of impulsive behaviour. Psychopharmacology 146, 482491.
Roiser JP, Rubinstein JS, Sahakian BJ (2003). Cognition in depression. Psychiatry 2, 4347.
Rubia K (2011). ‘Cool’ inferior frontostriatal dysfunction in attention-deficit/hyperactivity disorder versus ‘hot’ ventromedial orbitofrontal-limbic dysfunction in conduct disorder: a review. Biological Psychiatry 69, 6987.
Rubia K, Russell T, Overmeyer S, Brammer MJ, Bullmore ET, Sharma T, Simmons A, Williams SCR, Giampietro V, Andrew CM, Taylor E (2001). Mapping motor inhibition: conjunctive brain activation across different versions of Go/NoGo and Stop tasks. NeuroImage 13, 250261.
Rubia K, Smith A, Taylor E, Brammer M (2007). Temporal lobe dysfunction in medication-naïve boys with attention deficit/hyperactivity disorder during attention allocation. Biological Psychiatry 62, 9991006.
Sahakian BJ, Morein-Zamir S (2011). Depression and resilience: insights from cognitive, neuroimaging and psychopharmacological studies. In Decision Making, Affect, and Learning: Attention and Performance XX111. (ed. Delgado M. R., Phelps E. A. and Robbins T. W.), pp. 505532. Oxford University Press: New York.
Sarkis SM, Sarkis EH, Marshall D, Archer J (2005). Self-regulation and inhibition in comorbid ADHD children: an evaluation of executive functions. Journal of Attention Disorders 8, 96108.
Schacher R, Logan GD (1990). Impulsivity and inhibitory control in normal development and childhood psychopathology. Developmental Psychology 26, 710720.
Seguin JR, Pihl RO, Harden PW, Tremblay RE, Boulerice B (1995). Cognitive and neuropsychological characteristics of physically aggressive boys. Journal of Abnormal Psychology 104, 614624.
Seidman LJ, Biederman J, Monuteaux MC, Doyle A, Faraone SV (2001). Learning disabilities and executive dysfunction in boys with attention-deficit/hyperactivity disorder. Neuropsychology 15, 544556.
Siegel RA (1978). Probability of punishment and suppression of behavior in psychopathic and nonpsychopathic offenders. Journal of Abnormal Psychology 87, 514522.
Thapar A, Harrington R, McGuffin P (2001). Examining the comorbidity of ADHD related behaviours and conduct problems using a twin study design. British Journal of Psychiatry 179, 224229.
Toplak ME, Jain U, Tannock R (2005). Decision-making and cognitive abilities in adolescents with Attention-Deficit-Hyperactivity Disorder (ADHD). Behavioral and Brain Functions 1, 8.
Toupin J, Déry M, Pauzé R, Mercier H, Fortin L (2000). Cognitive and familial contributions to conduct disorder in children. Journal of Child Psychology and Psychiatry 41, 333344.
Vance A, Maruff P, Barnett R (2003). Attention deficit hyperactivity disorder, combined type (ADHD-CT): better executive function performance with longer-term psychostimulant medication. Australian and New Zealand Journal of Psychiatry 37, 570576.
van Goozen SH, Cohen-Kettenis PT, Snoek H, Matthys W, Swaab-Barneveld H, van Engeland H (2004). Executive functioning in children: a comparison of hospitalised ODD and ODD/ADHD children and normal controls. Journal of Child Psychology and Psychiatry 45, 284292.
Vitelli R (1998). Childhood disruptive disorders and adults psychopathy. American Journal of Forensic Psychology 16, 2937.
Wechsler D (1999). Wechsler Abbreviated Scale of Intelligence. The Psychological Corporation: San Antonio, TX.
Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biological Psychiatry 57, 13361346.
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