Past research suggests children with ADHD, like adults with frontal lobe damage, may have an impairment that affects their strategic planning – the ability to prioritise problems. The trouble is, this research has tended to involve tasks that are cognitively demanding or that tap into a specific mental ability (e.g. verbal fluency), so that the observed impairment to strategic planning could just be a side-effect of generally poor performance. Now Ora Kofman (University of the Negev, Beersheva, Israel) and colleagues have developed a simple, cognitively undemanding task that they say shows children with ADHD do seem to have difficultly prioritising problems.

Forty children aged between eight and thirteen years diagnosed with ADHD, and forty age-matched healthy controls, were presented with pairs of icons and shapes, and their task was to indicate in each case whether the two items in each pair were the same or not. Before the first attempt, the children were told that the pairs surrounded by a frame (i.e. a dotted line around the pair) were worth ten points for a correct answer, whereas all other pairs were worth one point. Half the pairs were framed. The children were told they had four minutes to earn as many points as possible but that they were not expected to be able to finish all 360 pairs.

On the first trial, only a few children in each group adopted the best strategy, which is obviously to answer all the framed pairs first.  After the children's first effort, the researchers explained the best strategy to them  and their understanding was checked before they had another go. 

The key finding is that the control children benefited far more from having the superior strategy explained to them than did the children with ADHD, even after controlling for the influence of IQ on the results. On the second trial, 23 out of 40 of the children with ADHD consistently used the strategy (performance did not vary according ADHD subgroup: inattentive only or inattentive and hyperactive), compared with 36 out of 40 of the controls. Many of the children with ADHD would start off using the strategy but then they would resume answering the items in order. This suggests their deficit is not simply one of distractability (they were still answering the items) but a more specific problem of prioritising, and maintaining a strategy. By contrast, the control children either used the strategy all the way through or not at all.

The researchers said it was promising to note that some of the children with ADHD did benefit from having the best strategy explained to them, an observation that could have therapeutic implications. "For example, instead of telling a child to 'get ready for school', the child could be trained on each component, such as choosing and laying out clothes, dressing, packing school-bag, and so on in a fixed order," they said. The researchers also suggested their new test of strategic planning could be combined with neuroimaging to "elucidate the neural substrate of planning and intentionality."

Web Directions

Kofman, O., Larson, J.G. & Mostofsky, S.H. (In Press). A novel task for examining strategic planning: Evidence for impairment in children with ADHD. Journal of Clinical and Experimental Neuropsychology.