Elsevier

Clinical Psychology Review

Volume 30, Issue 8, December 2010, Pages 951-961
Clinical Psychology Review

Self-regulation in ADHD: The role of error processing

https://doi.org/10.1016/j.cpr.2010.06.010Get rights and content

Abstract

Attention-deficit hyperactivity disorder (ADHD) is characterized by persistent and impairing developmentally inappropriate levels of inattention, hyperactivity, and impulsivity. Such behavioral dysregulation may be a consequence of deficits in self-monitoring or adaptive control, both of which are required for adaptive behavior. Processing of contextual demands, ongoing monitoring of one's behavior to evaluate whether it is appropriate for a particular situation, and adjusting behavior when it is suboptimal are components of self-regulation. This review examines and integrates the emerging literature on error-processing and adaptive control as components of self-regulation into the prominent etiological theories of ADHD. Available data on error-processing, as reflected in event-related potentials (ERN and Pe) and behavioral performance, suggest that both early error detection and later error-evaluation may be diminished in ADHD, thereby interfering with adaptive control processes. However, variability in results limit broad conclusions, particularly for early error detection. A range of methodological issues, including ERP parameters and sample and task characteristics, likely contribute to this variability, and recommendations for future work are presented. The emerging literature on error-processing and adaptive control informs etiological theories of ADHD in general and may provide a method for testing self-regulation models in particular.

Research highlights

► Self-regulation (error processing and adaptive control) may be impaired in ADHD. ► Studies examining neural correlates of error-processing in ADHD are inconsistent. ► Important to consider methodological factors and theoretical implications.

Introduction

ADHD is one of the most commonly diagnosed childhood disorders, occurring in approximately 5% of the world population (Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007). Children receiving a diagnosis of ADHD display persistent levels of inattentive and/or hyperactive and impulsive behavior that is developmentally inappropriate and causes significant impairment across situations (DSM-IV; American Psychiatric Association, 2000). Stimulant medication and contingency management improve behavior (Faraone & Buitelaar, 2009, Pelham & Fabiano, 2008) and the cognitive processes that are implicated in ADHD (Luman et al., 2005, Pietrzak et al., 2006). The purpose of this review is to elaborate prominent etiological theories of ADHD through integration with the relevant cognitive neuroscience literature regarding self-regulation. Empirical evidence for impairments in neurophysiological and behavioral correlates of self-regulatory processes including self-monitoring (e.g., error-processing) and adaptive control in ADHD will be reviewed to facilitate and improve research on this important topic.

Section snippets

Etiological theories of ADHD: cognition, motivation, and self-regulation

Heterogeneity of ADHD and variability of symptom presentation in particular settings (Douglas, 1999) pose a significant challenge for etiological theories of the disorder. Until recently, such theories have emphasized deficits in either cognition or motivation, though there are recent attempts at integration of these domains. Cognitive dysfunction theories of ADHD initially postulated single cognitive deficits in sustained attention, response inhibition (i.e., the ability to withhold a

Cognitive neuroscience models of self-regulation

Cognitive neuroscience researchers use neurophysiological indices of error processing to examine components of self-regulation and related factors.2

Self-regulation: self-monitoring processes

The role of self-monitoring has been neglected in most etiological theories of ADHD. The cognitive-energetic model (Sergeant et al., 2003) may come closest in this regard. It includes an overriding management system that is responsible for the detection of suboptimal performance, including errors, via self-monitoring and the correction of behavior to meet the task demands via influence on the effort pool. Similarly, Douglas' (1999) regulatory deficiency model has been extended to include

Self-regulation: adaptive control processes

In addition to self-monitoring, self-regulation requires adaptive control processes to adjust behavior when an error is detected. Post-error slowing, or an increase in response time on trials following an error, is a common behavioral indicator of adaptive control. This post-error slowing is construed as a compensatory mechanism intended to improve performance on subsequent trials (Rabbitt, 1966). Thus, a failure to slow responding on post-error trials has been interpreted as reflecting

Error processing in ADHD: ERN and Pe

Over the past 5 years, the literature on the neurophysiology of error-processing in ADHD has gone from non-existent to 13 studies, 9 of which have been conducted with children. These studies were identified via PubMed using the search terms “ADHD AND (“ERN” or “Pe”). This search produced 27 results with an available Epub prior to March 2010. Studies that did not include a group of children diagnosed with ADHD were excluded from this review. In addition, given developmental trends in the ERN and

Behavioral indices of adaptive control: relation to error processing

A goal in many of the studies of error processing is to consider how self-monitoring is related to behavioral outcomes. Studies that have examined behavioral post-error processes among children with ADHD have also produced inconsistent results. Sergeant and van der Meere (1988) found that ADHD participants failed to show adaptive post-error slowing as the task demands increased relative to controls. Diminished post-error slowing in children with ADHD was also found in studies involving a Stop

Summary and recommendations

Self-regulation has been implicated in prominent theories of ADHD (Douglas, 1999, Sergeant, 2000) and is gaining research attention as single core deficit models are increasingly viewed as insufficient to understand this heterogeneous disorder (Nigg, 2006, Pennington, 2006, Willcutt et al., 2005). However, empirical studies of self-regulation have proven difficult due to the complexity of this construct and the relative lack of reliable and valid measures of the relevant processes. Fortunately,

Acknowledgments

Preparation of this manuscript was supported in part by R01MH069434 to LWH and the University at Buffalo Department of Psychology Jacobs Scholarship to KS.

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