ADHD Outside the Laboratory: Boys' Executive Function Performance on Tasks in Videogame Play and on a Visit to the Zoo

One current theory of attention-deficit/hyperactivity disorder (ADHD) proposes that a primary deficit in behavioral inhibition gives rise to secondary deficits in 4 executive functions and motor control. To date, empirical support for this model is based primarily on laboratory-based cognitive methods. This study assessed behavioral inhibition and executive functioning in children with ADHD in 2 real-life contexts: videogames (motor-skill target game, cognitively demanding adventure game) and an outing at the zoo (route tasks). Participants were a community sample of 57 boys diagnosed with ADHD (20 inattentive, 37 combined type) and 57 normally developing control boys, matched individually for age and nonverbal IQ. Operationally defined measures of behavioral inhibition and specific executive functions were derived from these activities and assessed under contrasting conditions of low or high working memory and distractor loads. There were no group differences in basic motor skills on the target game, nor in terms of the ability to inhibit a prepotent or ongoing response in the adventure videogame. However, boys with ADHD exhibited more self-talk, more effortful response preparation, and completed fewer challenges in the latter videogame. Also, they manifested inhibition deficits in terms of interference control during the route task at the zoo and took longer to complete the tasks. Typically, these differences were greatest under conditions of high working memory and distractor loads. Findings from this study suggest that cognitive difficulties in ADHD may be context dependent and that ADHD is associated with deficits in some but not all aspects of behavioral inhibition.