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Differential Diagnosis of Adults With ADHD: The Role of Executive Function and Self-Regulation

J Clin Psychiatry 2010;71(7):e17
10.4088/JCP.9066tx1c

Adult ADHD is conceptualized as a disorder of age-inappropriate behavior that occurs because of maldevelopment of 2 related neuropsychological domains. The neuropsychological symptoms seen in adults with ADHD may be explained by deficits in executive function, which can be broadly defined as a set of neurocognitive processes that allow for the organization of behavior across time so as to attain future goals. Executive function is comprised of 2 broad domains: inhibition and metacognition. Inhibition encompasses the ability to inhibit motor, verbal, cognitive, and emotional activities. In turn, deficits in inhibition contribute to deficits in the development of 4 aspects of executive function in the domain of metacognition, which include nonverbal working memory, verbal working memory, planning and problem-solving, and emotional self-regulation. Understanding the ways in which deficits in executive function contribute to the symptoms of ADHD can help in differentiating ADHD from disorders that share similar characteristics.

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