Objective To investigate differences in multidimensional executive functions among children with attention-deficit/hyperactivity disorder (ADHD) at high or low anxiety levels compared to typically developing (TD) children, so as to provide evidence for targeted interventions in ADHD. Methods A cross-sectional study was conducted on 394 children (aged 7 - 14 years) diagnosed with ADHD between 2017 and 2024.Participants were categorized into a high-anxiety group (ADHD+ANX, n=100) and a low-anxiety group (ADHD-ANX, n=294) based on the anxiety factor scores from the Conners′ Parent Rating Scale.Additionally, 90 TD children were recruited as healthy controls.All participants were assessed using the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-Ⅳ), Trail Making Test (TMT), Stroop Color-Word Test, and the Cambridge Neuropsychological Test Automated Battery (CANTAB).Group comparisons were conducted using analysis of covariance (ANCOVA) or the Kruskal-Wallis test, with age and sex controlled as covariates, and the Bonferroni correction was applied for multiple comparisons. Results There were significant group differences across multiple measures, including total scores on the WISC-Ⅳ (F=27.981, P<0.001), Trail Making Test switching time (H=23.536, P<0.001), Stroop color-word interference time (H=8.461, P=0.001), Rapid Visual Information Processing A-prime task of CANTAB (RVPA, F=7.473, P=0.001), number of errors in go-signal trials (SSTDEG, F=9.458, P<0.001), and five-choice reaction time measures (e.g., RTIFMDRT, F=14.843, P<0.001). Both ADHD groups performed worse than the healthy control group across these indices (all P<0.05). Additionally, for mean latency in the Rapid Visual Information Processing task (RVPMDL, P<0.001), Spatial Working Memory Between Errors (SWMBE, P=0.003), and stop-signal reaction time (SSTSSRT, P=0.011), statistically significant differences were observed only between the ADHD-ANX group and the control group (all P<0.05). In contrast, for errors in stop-signal trials (SSTDES), only the ADHD+ANX group showed significantly poorer performance compared with the control group (P=0.001). Conclusion Children with ADHD exhibit multidimensional executive function impairments compared with TD children, and a high anxiety level was not associated with more extensive executive dysfunction.
Key words
attention-deficit/hyperactivity disorder /
anxiety /
executive function /
neuropsychological tests
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