Self-esteem in children and adolescents with and without attention-deficit/hyperactivity disorder: A meta-analytic review.

Meta-analytic methods were used to examine global and domain-specific (i.e., academic, social, behavioral) self-esteem in children and adolescents with and without ADHD. Potential moderators of effect size heterogeneity were also examined via meta-regressions within a three-level approach. Findings from 49 aggregated global self-esteem effect sizes (ADHDN = 2500, TDN = 9448), 12 academic self-esteem effect sizes (ADHDN = 386, TDN = 315), 11 social self-esteem effect sizes (ADHDN = 258, TDN = 254), and 8 behavioral self-esteem effect sizes (ADHDN = 231, TDN = 211) suggest that children and adolescents with ADHD experience moderate global (ES = 0.46, p < .001), academic (ES = 0.60, p = .009), and social (ES = 0.67, p = .001) self-esteem impairments compared to children and adolescents without the disorder. The aggregated behavioral self-esteem effect size (ES = 0.20, p = .54), however, was not significant, and the global self-esteem effect size was markedly smaller compared to effect sizes for the academic and social domains. Further, examination of potential moderators of effect size heterogeneity indicated null effects for medication status, diagnostic complexity, informant, age, sex, comorbid psychopathology, and self-esteem dimension. Collectively, findings suggest that children and adolescents with ADHD do not hold a ubiquitous negative self-perception of difficulties across academic, social, and behavioral domains of functioning, and unexamined domains that are distal to ADHD may serve to bolster global self-esteem.

Social functioning in children with ADHD: an examination of inhibition, self-control, and working memory as potential mediators.

Children with attention-deficit/hyperactivity disorder (ADHD) experience a host of social problems, in addition to significant impairments in behavioral inhibition, working memory, and self-control. Behavioral inhibition and working memory difficulties have been linked with social functioning deficits, but to date, most studies have examined these neurocognitive problems either in isolation or as an aggregate measure in relation to social problems, and none has considered the role of self-control. Thus, it remains unclear whether all of these executive functions are linked with social problems or if the link can be more parsimoniously explained by construct overlap. Fifty-eight children with ADHD and 63 typically developing (TD) children completed tests assessing self-control, behavioral inhibition, and working memory; parents and teachers rated children's social functioning. Examination of potential indirect effects with the bootstrapping procedure indicated that working memory mediated the relation between group membership (ADHD, TD) and child social functioning based on teacher but not parent ratings. Behavioral inhibition and self-control did not have direct relations with either parent- or teacher-rated social functioning. These findings point to important differences regarding how executive functioning difficulties manifest at school compared to home, as well as the specific executive function components that predict ADHD-related social difficulties.

Phonological working memory in children with and without ADHD: A systematic evaluation of recall errors.

OBJECTIVE: Phonological working memory impairments associated with attention-deficit/hyperactivity disorder (ADHD) have garnered interest due to reliable evidence of moderate- to large-magnitude between-group (ADHD vs. control) effects, as well their association with a wide range of secondary impairments. However, previous studies are methodologically limited in their ability to identify potential underlying mechanistic processes. This study aimed to examine converging and diverging patterns of omission, intrusion, and transposition errors to parse-specific mechanistic processes that contribute to ADHD-related phonological working memory deficits. METHOD: Fifty-four children with ADHD (45 males, nine females) and 65 typically developing (TD; 50 males, 15 females) children aged 8-12 (M = 9.62, SD = 1.52) years completed a computer-based phonological working memory task that aurally presented a random series of jumbled numbers and one letter. Children were instructed to verbally respond by stating the numbers from least to greatest, followed by the letter. Children's incorrect responses were coded as errors of omission, intrusion errors, or transposition errors. RESULTS: Results indicated a significant moderate-magnitude between-group difference in total omission and transposition errors, and a significant small-magnitude between-group difference in total intrusion errors. An examination of specific error types supported evidence of ADHD-related deficits in reordering and updating central executive processes. CONCLUSION: Collectively, these findings contribute to a more precise understanding of underlying mechanistic processes in ADHD-related working memory deficits and hold potential to inform the development of novel working memory metrics and working memory-based interventions for ADHD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Visuospatial working memory in attention-deficit/hyperactivity disorder: Characterizing path length and path crossings as mechanisms of impairment.

OBJECTIVE: A growing body of research provides reliable evidence of moderate to large magnitude deficits in the visuospatial (VS) working memory (WM) of children with attention-deficit/hyperactivity disorder (ADHD), relative to typically developing (TD) children. Studies of ADHD-related Visuo-spatial Working Memory (VS-WM) functioning most often present sequential presentations of VS stimuli and examine general performance characteristics. Only a few studies have examined the effects of varying VS-WM task parameters on performance in children with ADHD, despite evidence from basic-cognitive research that indicates methodological heterogeneity in VS-WM task parameters yields significant performance variability that is associated with underlying mechanistic processes. This study is the first to examine the effect of the task parameters path characteristics and path crossings on performance in children with ADHD and TD children. METHOD: School-aged children with ADHD (n = 50) and TD children (n = 59) completed a VS-WM task that varied by path lengths and path crossings. RESULTS: Multilevel analyses indicated a negative effect of relatively long paths on VS-WM performance of both TD children and children with ADHD, and a negative effect of increasing path crossings that appears to be unique to TD children and dependent on path length. CONCLUSIONS: Overall, findings appear to suggest that school-aged children engage in dynamic rehearsal of VS information (i.e., mental rehearsal of path sequences), rather than static rehearsal (i.e., rehearsal of a gestalt). Moreover, ADHD-related VS-WM deficits are most likely to yield real-world impairments when information is presented with relatively long path lengths. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Feature Binding and Working Memory in Children with ADHD: Evidence of Episodic Buffer Impairment.

Previous examinations of working memory impairments in children with attention-deficit/hyperactivity disorder (ADHD) have predominantly focused on discreet visuospatial and phonological subsystem processes, as well as the domain-general central executive. The episodic buffer component of working memory, a neurocognitive process that allows for temporary storage and maintenance of bound episodes/features of information, is understudied in ADHD and initial findings have been equivocal. Heterogeneity in previous findings may reflect between-study methodological variability, floor effects unrelated to episodic buffer processes (i.e., excessive central executive demands), and limitations associated with previous investigations' use of novel paradigms. This study examined ADHD-related episodic buffer processing via an established paradigm (Allen et al., 2006) in well-defined groups of children with attention-deficit/hyperactivity disorder (ADHD) and typically developing peers (TD). Seventy-one children (ADHD n = 34, TD n = 37) aged 8-12 years (M = 9.81, SD = 1.50; 32% female) completed two conditions of a computerized working memory task that presented single feature stimuli (color and shape), and a third condition that presented dual-feature stimuli (color/shape binding). Overall, the ADHD group exhibited a large-magnitude deficit during the color/shape binding condition (d = .77), and both groups evinced worse performance accuracy in the color/shape binding condition compared to the single feature color and shape conditions. Collectively, these findings appear to provide evidence that children with ADHD exhibit large magnitude episodic buffer deficits that are not attributable to visuospatial subsystem or domain-general central executive processes.

Attention-deficit/hyperactivity disorder and risk-taking: A three-level meta-analytic review of behavioral, self-report, and virtual reality metrics.

Meta-analytic methods were used to examine ADHD-related risk-taking in children and adults, and to compare the magnitude of risk taking across behavioral, self-report, and virtual reality metrics. Potential moderators of effect size heterogeneity were also examined via a three-level multi-level approach and a hybrid meta-analytic/systematic review approach. Aggregated effect sizes obtained from 56 behavioral-task studies (82 effect sizes; ADHDN = 2577; TDN = 2606), 51 self-report studies (130 effect sizes; ADHDN = 18,641; TDN = 113,163), and 8 virtual reality studies (16 effect sizes; ADHDN = 382; TDN = 436) suggest that children and adults with ADHD exhibit moderately more risk-taking compared to children and adults without the disorder. Notably, the aggregated effect size obtained from virtual reality simulations (Hedges', g = 0.43) was 30-40% larger than effect sizes obtained from self-report and behavioral task metrics (Hedges' g = 0.31 and 0.27), respectively. Suboptimal Decision Making was the only significant moderator identified via multi-level modeling; however, comparison of subgroup effect sizes revealed potential moderating effects of ADHD presentation and trial-by-trial feedback on behavioral tasks. Collectively, findings suggest that ADHD is reliably associated with small to moderate magnitude greater risk-taking behavior and virtual reality simulations appear be the most sensitive currently available metric.

Emotion Regulation and Children With Attention-Deficit/Hyperactivity Disorder: The Effect of Varying Phonological Working Memory Demands.

Objective: Findings from extant studies of the relationship between ADHD-related emotion regulation and working memory deficits have been equivocal, and their correlational designs preclude inferences about the functional relationship between working memory demands and emotion regulation. This study aimed to experimentally examine the functional relationship between varying working memory demands and ADHD-related emotion regulation deficits. Method: Overt emotion regulation behaviors were coded while children with and without ADHD completed experimental tasks that manipulated low and high working memory demands. Results: Compared with typically developing children, children with ADHD exhibited large-magnitude overall emotion expression deficits, disproportionately greater self-criticism during high working memory conditions, and disproportionately greater positive emotion expression during low working memory demand conditions. Conclusion: These findings suggest that working memory demands are functionally related to emotion regulation deficits exhibited by children with ADHD and may explicate variability of emotion regulation difficulties related to environmental demands.

Psychological adjustment outcomes among pediatric brain tumor survivors: A meta-analysis.

BACKGROUND: Pediatric brain tumor survivors (PBTS) are at significant risk for psychological adjustment difficulties, including greater depressive and anxious symptomology. Systematic reviews have identified this heightened risk among youth with medical conditions, but these reviews have not been specific to PBTS. Therefore, the current study aimed to directly examine the psychological adjustment of PBTS as compared to healthy peers. PROCEDURE: A systematic review and meta-analysis was conducted using PubMed, PsychInfo, and Academic Search Premier databases. The search yielded 2833 articles, with 22 articles meeting inclusion criteria. RESULTS: A statistically significant overall medium effect size (Hedge's g = 0.32) indicated that PBTS exhibited poorer overall psychological adjustment relative to healthy comparison groups. Studies that included younger children were associated with larger between-group differences. When evaluating specific outcomes, PBTS had relatively higher levels of depressive symptoms (Hedge's g = 0.36), anxious symptoms (Hedge's g = 0.11), and general distress (Hedge's g = 0.22), but not more externalizing problems. CONCLUSIONS: The present study confirmed that PBTS are indeed at greater risk for psychological adjustment difficulties relative to healthy comparison groups. These findings highlight the importance of psychosocial screening among this population. Given that depressive symptoms were the most elevated relative to healthy peers, investigation of such symptomatology among PBTS is particularly important.

The Relationship Between Parent Distress and Child Quality of Life in Pediatric Cancer: A Meta-Analysis.

PROBLEM: Pediatric cancer places both parents and children at risk for psychosocial difficulties, including a specific risk for diminished quality of life. Previous research has identified relationships between parent and child psychosocial adjustment outcomes (e.g., depression, anxiety), yet the relationships between parent adjustment and child quality of life have yet to be comprehensively evaluated via meta-analysis. ELIGIBILITY CRITERIA: A systematic review and meta-analysis were conducted using EBSCO, with PsychINFO, MEDLINE, Academic Search Premiere, and Health Source: Nursing/Academic Edition. SAMPLE: Fourteen studies met inclusion criteria. RESULTS: Fourteen correlations from 1646 parents of children with cancer were evaluated, resulting in a medium-magnitude correlation between parent psychosocial adjustment and child quality of life (r = 0.23, p < .001). Additional analyses evaluating the relationship between parent psychosocial adjustment and child social/emotional quality of life resulted in a medium-magnitude correlation (r = 0.24, p < .001). CONCLUSIONS: A significant relationship exists between parent psychosocial adjustment and child quality of life. However, this relationship appears slightly less strong than those found in meta-analyses evaluating other child psychosocial adjustment outcomes. IMPLICATIONS: Parent distress is an important factor to evaluate in the context of pediatric cancer, as it appears to have implications for child quality of life, in addition to other child psychosocial adjustment outcomes.

Planning deficits in children with attention-deficit/hyperactivity disorder (ADHD): A meta-analytic review of tower task performance.

OBJECTIVE: Deficient planning is commonly observed among children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and is associated with several adverse outcomes. The current meta-analysis expands on previous reviews by examining performance and latency metrics across five tower planning task variants, in addition to applying metaregression techniques to examine potential moderating effects. METHOD: Forty-one studies (NADHD = 2,051; NTD = 2,766) provided sufficient information to calculate between-group effect sizes and were included in the current study. RESULTS: Results revealed moderate-magnitude planning deficits exhibited by children with ADHD, ranging from Hedge's g of 0.36 to 0.59. Analysis of latency metrics revealed small- to moderate-magnitude between-groups differences (Hedge's g ranging from -0.42 to 0.41), such that children with ADHD responded more quickly on planning tasks when compared with typically developing peers. Age, percentage of females, solution presentation (e.g., pictorial vs. physical display), and task complexity (beads vs. disks) were identified as statistically significant moderating variables across planning metrics. CONCLUSIONS: Although aggregated findings suggest that children with ADHD, compared with typically developing children, exhibit moderate planning deficits, researchers and clinicians are advised to consider our findings of significant participant and task moderating variables when interpreting children's performance on tower tasks. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Working memory and behavioral inhibition in children with attention-deficit/hyperactivity disorder (ADHD): an examination of varied central executive demands, construct overlap, and task impurity.

The stop-signal paradigm is the premier metric of behavioral inhibition in contemporary attention-deficit/hyperactivity disorder (ADHD) research. The stop-signal paradigm's choice-reaction time component, however, arguably places greater demands on working memory processes (e.g., controlled-focused attention) relative to alternative inhibition metrics (i.e., go/no-go (GNG) tasks), and consequently obscures conclusions about inhibition and working memory deficits in affected children. The current study, therefore, aimed to determine whether shared variance between stop-signal behavioral inhibition and working memory performance in children with ADHD reflects overlap between the working memory and inhibition constructs or insufficient specificity of the stop-signal paradigm. Fifty-five children (8-12 years) with and without ADHD were administered established phonological (PH) and visuospatial (VS) working memory measures, as well as stop-signal and GNG tasks that vary with respect to demands on controlled-focused attention. Although working memory and GNG performance each uniquely predicted children's inattention, stop-signal task performance was not a significant predictor of unique variance in inattention, above and beyond variance associated with working memory. Collectively, these findings suggest that performance on the stop-signal task, compared to the GNG task, is confounded by greater demands associated with working memory and consequently reflects an impure estimate of the inhibition construct.

Inhibitory Control and Information Processing in ADHD: Comparing the Dual Task and Performance Adjustment Hypotheses.

Inhibition is a key neurocognitive domain in ADHD that is commonly assessed with the stop-signal task. The stop-signal involves both "go" and "stop" trials; previous research indicates that response times are reliably slower to "go" trials during tasks with vs. without intermittent "stop" trials. However, it is unclear whether this pattern reflects deliberate slowing to maximize inhibitory success (performance adjustment hypothesis) and/or disrupted bottom-up information processing due to increased cognitive demands (dual-task hypothesis). Given the centrality of "go" responding for estimating children's inhibitory speed, finding that children with ADHD slow differently -or for different reasons- has the potential to inform cognitive and self-regulatory theories of ADHD. The current study used a carefully-controlled experimental design to assess the mechanisms underlying stop signal-related slowing in ADHD. Children ages 8-13 with (n = 81) and without ADHD (n = 63) completed the stop-signal task and a control task that differed only in the presence/absence of "stop" trials. Using drift-diffusion modeling, Bayesian repeated-measures ANOVAs revealed a pattern consistent with the performance adjustment hypothesis, such that children adopted more cautious response strategies (BF10 = 6221.78; d = 0.38) but did not show changes in processing speed (BF01 = 3.08; d = 0.12) or encoding/motor speed (BF01 = 5.73; d = 0.07) when inhibition demands were introduced. Importantly, the ADHD/Non-ADHD groups showed equivalent effects of intermittent "stop" trials (BF01 = 4.30-5.56). These findings suggest intact self-regulation/performance monitoring in the context of adapting to increased inhibitory demands in ADHD, which has important implications for the continued isolation of potential mechanisms associated with ADHD symptoms and impairment.

Attention-deficit/hyperactivity disorder and phonological working memory: Methodological variability affects clinical and experimental performance metrics.

OBJECTIVE: Despite promising findings in extant research that suggest impaired working memory (WM) serves as a central neurocognitive deficit or candidate endophenotype of attention-deficit/hyperactivity disorder (ADHD), findings from translational research have been relatively underwhelming. This study aimed to explicate previous equivocal findings by systematically examining the effect of methodological variability on WM performance estimates across experimental and clinical WM measures. METHOD: Age-matched boys (ages 8-12 years) with (n = 20) and without (n = 20) ADHD completed 1 experimental (phonological) and 2 clinical (digit span, letter-number sequencing) WM measures. RESULTS: The use of partial scoring procedures, administration of greater trial numbers, and high central executive demands yielded moderate-to-large between-groups effect sizes. Moreover, the combination of these best-case procedures, compared to worst-case procedures (i.e., absolute scoring, administration of few trials, use of discontinue rules, and low central executive demands), resulted in a 12.5% increase in correct group classification. CONCLUSION: Collectively, these findings explain inconsistent ADHD-related WM deficits in previous reports, and highlight the need for revised clinical measures that utilize best-case procedures. (PsycINFO Database Record

Context influences decision-making in boys with attention-deficit/hyperactivity disorder: A comparison of traditional and novel choice-impulsivity paradigms.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by an impaired ability to maintain attention and/or hyperactivity/impulsivity. Impulsivity is frequently defined as the preference for small, immediate rewards over larger, delayed rewards, and has been associated with a variety of negative outcomes such as risky behavior and academic difficulty. Extant studies have uniformly utilized the traditional paradigm of presenting two response choices, which limits the generalization of findings to scenarios in which children/adolescents are faced with dichotomous decisions. The current study is the first to examine the effect of manipulating the number of available response options on impulsive decision-making in boys with and without ADHD. A total of 39 boys (ADHD = 16, typically developing [TD] = 23) aged 8-12 years completed a traditional two-choice impulsivity task and a novel five-choice impulsivity task to examine the effect of manipulating the number of choice responses (two vs five) on impulsive decision-making. A five-choice task was utilized as it presents a more continuous array of choice options when compared to the typical two-choice task, and is comparable given its methodological similarity to the two-choice task. Results suggested that boys with ADHD were significantly more impulsive than TD boys during the two-choice task, but not during the five-choice task. Collectively, these findings suggest that ADHD-related impulsivity is not ubiquitous, but rather dependent on variation in demands and/or context. Further, these findings highlight the importance of examining ADHD-related decision-making within the context of alternative paradigms, as the exclusive utilization of two-choice tasks may promote inaccurate conceptualizations of the disorder.

[Formula: see text]Working memory and behavioral inhibition in boys with ADHD: An experimental examination of competing models.

Working memory (WM) and behavioral inhibition impairments have garnered significant attention as candidate core features, endophenotypes, and/or associated neurocognitive deficits of attention-deficit/hyperactivity disorder (ADHD). The relationship between ADHD-related WM and inhibition deficits remains relatively unclear, however, with inferences about the constructs' directional relationship stemming predominantly from correlational research. The current study utilized a dual-task paradigm to experimentally examine the relationship between ADHD-related WM and behavioral inhibition deficits. A total of 31 boys (15 ADHD and 16 typically developing [TD]) aged 8-12 years completed WM (1-back and 2-back), behavioral inhibition (stop-signal task [SST]), and dual-condition (1-back/SST and 2-back/SST) experimental tasks. Children with ADHD exhibited significant, large-magnitude WM deficits for the 1-back condition but were not significantly different from children in the TD group for the 2-back, 1-back/SST, and 2-back/SST conditions. Children with ADHD also exhibited significant inhibition deficits for the SST, 1-back/SST, and 2-back/SST conditions, but the within-group effect was not significant. The findings suggest that ADHD-related stop-signal demands are upstream, or compete for, resources involved in controlled-focused attention and/or other central executive (CE), WM processes.

Hyperactivity in boys with attention-deficit/hyperactivity disorder: The influence of underlying visuospatial working memory and self-control processes.

Changes in motor activity were examined across control and executive function (EF) tasks that differ with regard to demands placed on visuospatial working memory (VS-WM) and self-control processes. Motor activity was measured via actigraphy in 8- to 12-year-old boys with (n=15) and without (n=17) attention-deficit/hyperactivity disorder (ADHD) during the completion of VS-WM, self-control, and control tasks. Results indicated that boys with ADHD, relative to typically developing boys, exhibited greater motor activity across tasks, and both groups' activity was greater during EF tasks relative to control tasks. Lastly, VS-WM performance, relative to self-control performance, accounted for significantly more variance in activity across both VS-WM and self-control tasks. Collectively, findings suggest that ADHD-related hyperactivity is positively related to increased cognitive demands and appears to be better explained by deficient VS-WM rather than insufficient self-control.

Choice-impulsivity in children and adolescents with attention-deficit/hyperactivity disorder (ADHD): A meta-analytic review.

Impulsive behavior is a core DSM-5 diagnostic feature of attention-deficit/hyperactivity disorder (ADHD) that is associated with several pejorative outcomes. Impulsivity is multidimensional, consisting of two sub-constructs: rapid-response impulsivity and reward-delay impulsivity (i.e., choice-impulsivity). While previous research has extensively examined the presence and implications of rapid-response impulsivity in children with ADHD, reviews of choice-impulsive behavior have been both sparse and relatively circumscribed. This review used meta-analytic methods to comprehensively examine between-group differences in choice-impulsivity among children and adolescents with and without ADHD. Twenty-eight tasks (from 26 studies), consisting of 4320 total children (ADHD=2360, TD=1,960), provided sufficient information to compute an overall between-group effect size for choice-impulsivity performance. Results revealed a medium-magnitude between-group effect size (g=.47), suggesting that children and adolescents with ADHD exhibited moderately increased impulsive decision-making compared to TD children and adolescents. Further, relative to the TD group, children and adolescents with ADHD exhibited similar patterns of impulsive decision-making across delay discounting and delay of gratification tasks. However, the use of single-informant diagnostic procedures relative to multiple informants yielded larger between-group effects, and a similar pattern was observed across samples that excluded females relative to samples that included females.

Hyperactivity in boys with attention-deficit/hyperactivity disorder (ADHD): The role of executive and non-executive functions.

Motor activity of boys (age 8-12 years) with (n=19) and without (n=18) ADHD was objectively measured with actigraphy across experimental conditions that varied with regard to demands on executive functions. Activity exhibited during two n-back (1-back, 2-back) working memory tasks was compared to activity during a choice-reaction time (CRT) task that placed relatively fewer demands on executive processes and during a simple reaction time (SRT) task that required mostly automatic processing with minimal executive demands. Results indicated that children in the ADHD group exhibited greater activity compared to children in the non-ADHD group. Further, both groups exhibited the greatest activity during conditions with high working memory demands, followed by the reaction time and control task conditions, respectively. The findings indicate that large-magnitude increases in motor activity are predominantly associated with increased demands on working memory, though demands on non-executive processes are sufficient to elicit small to moderate increases in motor activity as well.

Visuospatial working memory underlies choice-impulsivity in boys with attention-deficit/hyperactivity disorder.

The present study examined the directional relationship between choice-impulsivity and separate indices of phonological and visuospatial working memory performance in boys (aged 8-12 years) with (n=16) and without ADHD (n=19). Results indicated that high ratings of overall ADHD, inattention, and hyperactivity were significantly associated with increased impulsivity and poorer phonological and visuospatial working memory performance. Further, results from bias-corrected bootstrapped mediation analyses revealed a significant indirect effect of visuospatial working memory performance, through choice-impulsivity, on overall ADHD, inattention, and hyperactivity/impulsivity. Collectively, the findings suggest that deficits of visuospatial working memory underlie choice-impulsivity, which in turn contributes to the ADHD phenotype. Moreover, these findings are consistent with a growing body of literature that identifies working memory as a central neurocognitive deficit of ADHD.

Working memory deficits in boys with attention deficit/hyperactivity disorder (ADHD): An examination of orthographic coding and episodic buffer processes.

The episodic buffer component of working memory was examined in children with attention deficit/hyperactivity disorder (ADHD) and typically developing peers (TD). Thirty-two children (ADHD = 16, TD = 16) completed three versions of a phonological working memory task that varied with regard to stimulus presentation modality (auditory, visual, or dual auditory and visual), as well as a visuospatial task. Children with ADHD experienced the largest magnitude working memory deficits when phonological stimuli were presented via a unimodal, auditory format. Their performance improved during visual and dual modality conditions but remained significantly below the performance of children in the TD group. In contrast, the TD group did not exhibit performance differences between the auditory- and visual-phonological conditions but recalled significantly more stimuli during the dual-phonological condition. Furthermore, relative to TD children, children with ADHD recalled disproportionately fewer phonological stimuli as set sizes increased, regardless of presentation modality. Finally, an examination of working memory components indicated that the largest magnitude between-group difference was associated with the central executive. Collectively, these findings suggest that ADHD-related working memory deficits reflect a combination of impaired central executive and phonological storage/rehearsal processes, as well as an impaired ability to benefit from bound multimodal information processed by the episodic buffer.