Cross-Cultural Variations in Executive Function Deficits among Children with ADHD

Executive function (EF) deficits are heterogeneous in ADHD children. Culture has a significant impact on EF development in typically developing populations, but its impact on EF deficits in children with ADHD is understudied. This study aims to investigate the impact of cultural factors on EF deficits in children with ADHD through a cross-cultural comparison. To ensure a robust sample size, the study initially recruited a large participant pool of 631 children from China and Australia. To make the ADHD samples between countries comparable in terms of clinical representation, we applied similar diagnostic criteria and used propensity score matching to align ADHD severity. This approach resulted in a final sample of 198 children aged 7 to 12, including 102 children diagnosed with ADHD and 96 typically developing peers. The same neuropsychological testing battery was used to assess EF in terms of working memory, inhibitory control, and set shifting. Significant cultural effects were observed: Chinese children with ADHD showed lower performance in inhibitory control and working memory compared to their typically developing peers, a pattern not seen in Australian children. A latent profile analysis revealed distinct EF profiles, highlighting a subgroup of Chinese children with severe EF deficits. This study advances cross-cultural ADHD research on EF by using a robust methodology, including consistent diagnostic and testing procedures, propensity score matching, and person-centered analysis. Our findings suggest that high-EF-expectation environments may have a negative effect on EF in children with ADHD, which provides insight into the underlying cause of heterogeneous EF and underscores the need for culturally tailored ADHD interventions.