S anda diza ion o decision-making skills bu pe sis en impulsi i y a e
ch onic s imulan exposu e in ADHD pa ien s
F ancisco Jos´
e Loba o-Camacho
*
, Juan Ped o Va gas , Juan Ca los L´
opez
Depa amen o de Psicología Expe imen al, Facul ad de Psicología, Uni e sidad de Se illa, Calle Camilo Jos´
e Cela, S/N, 41018 Se illa, Spain
ARTICLE INFO
Keywo ds:
ADHD
Decision-making
Memo y
Long- e m s imulan ea men
Impulsi i y
Pa e n sepa a ion
ABSTRACT
A en ion de ici hype ac i i y diso de (ADHD) is commonly associa ed wi h de ici s in execu i e unc ion. E en
hough a en ion, hype ac i i y, and impulsi i y a e he mo e dis inc i e symp oms, impai men in o he
cogni i e p ocesses, o ins ance memo y, could be due o he in e e ences om hese symp oms. Howe e , i
emains unclea whe he in o ma ion p ocessing e o s made by indi iduals wi h ADHD a ise p ima ily om
impulsi e esponding o e lec a mo e undamen al di e ence in how hey p ocess in o ma ion, po en ially due
o compensa o y mechanisms de eloped h oughou childhood. This s udy analyzes pa e n sepa a ion (dis-
inguishing simila s imuli), ecogni ion memo y, decision-making, and impulsi i y in bo h ADHD-diagnosed and
non-diagnosed you h popula ion. We u he examined possible ea men e ec s by di iding he ADHD g oup
in o h ee coho s based on s imulan medica ion du a ion. We e alua e hei esponse la ency and esponses
u ilizing he signal de ec ion heo y me hod. While ADHD pa icipan s exhibi ed poo e ecogni ion memo y
compa ed o con ols, his pa e n did no show a s a is ically signi ican di e ence in pa e n sepa a ion.
Addi ionally, bo h p ocesses imp o ed wi h longe ea men du a ion wi hin he ADHD g oup, leading o
dec eased e o commission. Decision-making analyses e ealed sex-speci ic esponse s a egies wi hin he
ADHD g oup, bu bo h g oups showed simila adjus men o ask di icul y. Howe e , he ADHD g oup esponses
we e no ably as e , associa ed wi h a highe e o a e. Addi ionally, esponse imes a ied depending on he
s imulus ype, sugges ing po en ial di e ences in how he ADHD g oup p ocessed in o ma ion compa ed o he
con ol g oup. These indings collec i ely poin owa ds a possible di e ence in in o ma ion managemen in
ADHD, ha is also cha ac e ized by as e , bu less accu a e, p ocessing.
1. In oduc ion
Execu i e unc ions a e skills ha allow us o achie e goals (Loba o-
Camacho e al., 2023; San a-C uz and Rosas, 2017). Poo de elopmen
o hese unc ions, as a low capaci y in con ol p ocess, educes a a ie y
o highe -le el skills, leading o se ious p oblems mainly in childhood
(Fa aone e al., 2021). These ailu es a e usually associa ed wi h
wo king memo y de ici s, as e o s commi ed seem o be ela ed o a
dys unc ional cen al execu i e. Selec i e a en ion and i s con ol sys-
ems ha e been linked o execu i e unc ions. In ac , a en ion de ici
hype ac i i y diso de (ADHD) is cha ac e ized by de ici s in execu i e
unc ions, pa icula ly in con ol sys ems. Fu he mo e, ADHD is
beha io ally ma ked by a iad o ina en ion, hype ac i i y, and
impulsi i y symp oms, po en ially s emming om execu i e dys unc-
ion (Ame ican Psychia ic Associa ion, 2022).
Al hough all h ee symp oms nega i ely impac childhood,
ina en ion gene ally pe sis s h oughou li e, signi ican ly hinde ing
lea ning p ocesses (Fa aone e al., 2015, 2021). Speci ically, di icul ies
in memo y encoding and p ocessing de ails a e common mani es a ions
o ina en ion (Skodzik e al., 2017). This ci cums ance leads o an in-
c ease in e o a es in asks such as con inuous pe o mance es s, s op-
signal asks, and go/no-go asks, which may also be linked o impulsi e
symp oms as hey can esul om has y decision-making (Pa os e al.,
2016; Se ano-Ba oso e al., 2021, 2022). Howe e , i emains unclea
whe he hese inc eased e o a es a e a ibu able o impulsi i y,
a en ional de ici s, o a combina ion o bo h.
Cu en ly, he e is unce ain y abou he causes o symp oms in
ADHD. Po en ial explana ions include de ici s in speci ic neu o ans-
mi e s (Del Campo e al., 2011) o dys unc ions in neu onal ci cui s
(Yoo e al., 2018). Suppo ing his hypo hesis, signi ican di e ences
ha e been iden i ied in he es ing-s a e unc ional ne wo k and
ana omical connec i i y in indi iduals wi h ADHD (Kon ad and
* Co esponding au ho .
E-mail add esses: [email p o ec ed] (F.J. Loba o-Camacho), [email p o ec ed] (J.P. Va gas), [email p o ec ed] (J.C. L´
opez).
Con en s lis s a ailable a ScienceDi ec
Pha macology, Biochemis y and Beha io
jou nal homepage: www.else ie .com/loca e/pha mbiochembeh
h ps://doi.o g/10.1016/j.pbb.2025.173986
Recei ed 4 Janua y 2025; Recei ed in e ised o m 18 Feb ua y 2025; Accep ed 25 Feb ua y 2025
Pha macology, Biochemis y and Beha io 249 (2025) 173986
A ailable online 26 Feb ua y 2025
0091-3057/© 2025 The Au ho s. Published by Else ie Inc. This is an open access a icle unde he CC BY-NC-ND license ( h p://c ea i ecommons.o g/licenses/by-
nc-nd/4.0/ ).
Eickho , 2010; Yoo e al., 2018). In his con ex , i has been epo ed
ha he ailu e on a enua ion o he es ing-s a e in unc ional ne wo k
is associa ed wi h momen a y lapses in a en ion, mani es ed by longe
eac ion imes and less accu a e pe o mance in a en ion con ol asks
(Su cubasi e al., 2020). The in eg a ion o indings om s uc u al and
unc ional connec i i y s udies sugges s ha he educed global e i-
ciency o b ain ne wo ks obse ed in ADHD may be ela ed o a loss o
long- ange connec ions. These indings indica e ha in e e ence be-
ween neu al ne wo ks could be an unde lying ac o in cogni i e p o-
cess dys unc ion (Kon ad and Eickho , 2010). Consequen ly, lea ning
di icul ies could be due o de ici s in cogni i e p ocesses a he han
impulsi i y o a en ional de ici s. Thus, i is essen ial o de e mine i
commission e o s in ADHD pa ien s a e d i en by impulsi eness,
a en ional de ici s, o di e ences in p ocessing in o ma ion. Analyzing
disc epancies be ween ecogni ion memo y and a en ion o de ail could
help elucida e his ques ion.
A concep closely ela ed wi h a en ion o de ail is pa e n sepa a-
ion (Lacy e al., 2010). This abili y allows us o encode simila s imuli
dis inc ly in ou memo y, p e en ing hem om o e lapping and
in e e ing wi h each o he (Das e al., 2014). Essen ially, i ensu es clea
and sepa a e s o age o simila in o ma ion. In sum, his unc ion allows
us dis inguishing be ween di e en kind o objec s belongings he same
class o concep . In con as , ecogni ion memo y ocuses on iden i ying
p e iously encoun e ed s imuli (Das e al., 2019). In ecogni ion mem-
o y, we can ho oughly assess i s encoding and eco e y by acili a ing
he p esence o he s imulus (Hockley, 2022). Tes s aimed a measu ing
hese cogni i e p ocesses o en show how he commission o e o s is
clea ly ela ed o ADHD pa ien s. This ac is usually jus i ied by wai ing
impulsi i y o he endency o espond be o e he appea ance o he
a ge (Robinson e al., 2009). A as e esponse migh signi ican ly
dis o he lea ning assessmen , as i implies a lack o analysis o he
op ions. The e o e, his may no e lec he amoun o lea ning eached
and has a nega i e impac on ADHD (Ba i and Robbins, 2013). S anda d
memo y ecogni ion asks make i di icul o disce n whe he ela ed
issues a e due o impulsi eness, a en ional de ici s, o i is due o a
di e en way o p ocessing he in o ma ion.
In he p esen s udy, we ha e analyzed po en ial di e ences in in-
o ma ion p ocessing be ween young people wi h ADHD diagnoses and a
con ol g oup. We ocused on h ee key cogni i e p ocesses: pa e n
sepa a ion ( he abili y o dis inguish simila s imuli), ecogni ion
memo y ( he abili y o iden i y p e iously encoun e ed i ems), and
decision-making adjus men s (how indi iduals adap hei s a egies
unde a ying cogni i e demand). To explo e hese p ocesses, we e al-
ua ed esponse imes and esponse pa e ns. We employed asks a -
ge ing pa e n sepa a ion and objec ecogni ion memo y o compa e
in o ma ion p ocessing in bo h g oups. Fu he mo e, o he ADHD
g oup, we e alua ed he impac o s imulan ea men on ask pe o -
mance o e ime o examine whe he ea men du a ion a ec ed hei
in o ma ion p ocessing.
2. Me hod
2.1. Sample
This s udy included 96 pa icipan s, equally di ided in o wo g oups:
an ADHD g oup and a neu o ypical de elopmen (ND) (Table 1). The
ADHD g oup we e ec ui ed om he Ai eLib e Founda ion in Huel a,
Spain. No ably, his sample was p e iously used in a di e en s udy
(Loba o-Camacho e al., 2024b); howe e , and gi en he implica ions o
he o me , we ha e ex ended he analysis o di e en p ocesses in he
p esen s udy. All pa icipan s we e diagnosed wi h ADHD by he
Andalusian Public Heal h. They p esen ed mode a e ADHD symp oms,
including di icul ies in he school en i onmen , pee ela ionships and
amily dynamics. The ND g oup we e andomly ec ui ed om he La
Campi˜
na Educa ional Ins i u e in A ahal, Spain.
All pa icipan s p o ided w i en in o med consen be o e pa ici-
pa ing in he s udy. The s udy was conduc ed ollowing he guidelines o
he Decla a ion o Helsinki and ecei ed app o al om he Comi ´
e de
´
E ica de la Uni e sidad de Se illa (code: 2099-N22).
Pa icipan s in he ADHD g oup we e unde s imulan medica ion,
wi h 39 aking me hylphenida e and 9 lisdexam e amine. The p ima y
mechanism o ac ion o lisdexam e amine in ol es inc easing le els o
dopamine and no epineph ine in he b ain, a mechanism i sha es wi h
me hylphenida e (Fa aone and Au ho , 2018). These neu o ansmi e s
play a c ucial ole in egula ing a en ion, ocus, and impulse con ol,
hus explaining hei he apeu ic ole in ADHD. Bo h lisdexam e amine
and me hylphenida e demons a e simila p o iles in e ms o e icacy,
ole abili y, and sa e y, p o iding compa able he apeu ic bene i s o
indi iduals wi h ADHD (Fa aone and Au ho , 2018).
To in es iga e he po en ial impac o ea men du a ion, pa ici-
pan s we e ca ego ized in o h ee g oups based on ea men leng h
(Table 1): coho one <24 mon hs, coho wo be ween 25 and 72
mon hs, and coho h ee be ween 73 and 120 mon hs. This ca ego i-
za ion aligns wi h p e ious esea ch sugges ing a s onge medica ion
e ec on ce ain symp oms du ing he ini ial 24 mon hs o in ensi e
ea men , wi h a diminishing e ec obse ed he ea e (Ha pin e al.,
2016). To analyze he lowe e ec a e 24 mon hs o ea men , 48-
mon h in e als we e es ablished om ha momen .
2.2. Ma e ials
We used he Mnemonic Simila i y Task (MST) p og am, e sion 0.96
(S a k e al., 2019). The MST es is a well-es ablished ool o assessing
episodic memo y and hippocampal unc ion by measu ing he abili y o
ecall speci ic de ails o pas expe iences (Loba o-Camacho e al., 2024c;
S a k e al., 2023). This es is pa icula ly aluable o e alua ing he
e ec i eness o cogni i e and pha macological in e en ions o imp o e
memo y (S a k e al., 2023).
2.3. P ocedu e
The MST consis ed o wo consecu i e phases, adminis e ed wi hou
a b eak. Pa icipan s esponded o images p esen ed o wo seconds
each on a compu e sc een and esponded ia keyboa d inpu .
2.4. Lea ning phase
Du ing he lea ning phase, pa icipan s classi ied 192 images o
e e yday objec s. They had o indica e i he objec could be conside ed
as an inside home objec , p essing he numbe one key in he keyboa d
o ou side home p essing he numbe wo. This phase aimed o induce
inciden al lea ning. All pa icipan s iewed he same se o images.
2.5. Recogni ion phase
Once he lea ning phase ended, he pa icipan s pe o med a su p ise
memo y es . They we e asked o classi y 192 images as “old” (seen
be o e, p essing he numbe one in he keyboa d), “simila ” (Images
seen be o e wi h a de ail change, p essing he numbe wo), o “new”
(no p e iously encoun e ed, p essing he numbe h ee). This se
included 64 ‘ a ge ’ images (iden ical o hose in he lea ning phase), 64
Table 1
Age, gende and ea men du a ion in ADHD coho s.
N Age
(Mean ±SE)
T ea men ime
(Mon hs, Mean ±
SE)
Female (n) Male (n)
ND 48 14.29 ±0.31 –26 22
ADHD 48 13.85 ±0.34 45.66 ±4.56 14 34
Coho 1 19 13.30 ±0.52 15.10 ±1.76 6 13
Coho 2 19 13.01 ±0.60 51.15 ±3.09 5 14
Coho 3 10 14.90 ±0.61 93.30 ±4.27 3 7
F.J. Loba o-Camacho e al.
Pha macology, Biochemis y and Beha io 249 (2025) 173986
2
‘ oil’ images (comple ely new), and 64 ‘lu e’ images ( a ge images wi h
a de ail change). The p og am andomly chose he images g ouped as
a ge , lu e, and oil.
All pa icipan s comple ed he es du ing a single session. The ask
las ed one hou , and i was d i en by an expe clinical psychologis .
Pa icipan s ecei ed p in ed ins uc ions and could ask ques ions o
eques cla i ica ion. Bo h g oups unde ook he es s be ween 6:00 PM
and 8:00 PM. Pa icipan s wi h ADHD con inued wi h hei usual
medica ion egimen. This is, all pa icipan s ecei ed hei ea men
once daily in he mo ning, be o e a ending school, a app oxima ely
8:00 AM. Bo h pa icipan s aking me hylphenida e and hose aking
lisdexam e amine we e p esc ibed doses adjus ed o hei age and
weigh in ex ended- elease o mula ions.
2.6. Va iables
Independen a iables included sex, age, and ADHD diagnosis.
T ea men du a ion was also included as an independen a iable o he
ADHD g oup. As dependen a iables, we analyzed he esponse ime
(RT) and i s a iabili y o e alua e wai ing impulsi i y. Addi ionally, we
e alua ed he esponse bias (β) and disc imina ion (d’) in pa e n sep-
a a ion and ecogni ion memo y asks.
The disc imina ion index (d’) and he esponse bias (β) was calcu-
la ed as:
dʹ=Hi –False Ala m
ß=e(dʹ−c)
Hi s and alse ala ms (FA) in he pa e n sepa a ion was calcula ed
based on esponses o a ge and lu es s imuli (see Table annex 1).
Hi =Ta ge Old
(Ta ge Old) + (Ta ge Simila )
FA =Lu e Old
(Lu e Old) + (Lu e Simila )
Hi s and FA in he ecogni ion memo y was de i ed om esponses
o oil and a ge s imuli (see Table annex 1).
Hi =Foil New
(Foil New) + (Foil Old)
FA =Ta ge New
(Ta ge New) + (Ta ge Old)
2.7. Analysis o da a
We analyzed pa icipan esponses o he di e en s imuli o
compa e in o ma ion p ocessing in ADHD and ND g oups. To es ima e
he e ec size, Cohen’s d s a is ic was used, which measu es he di e -
ence be ween he means o wo g oups in s anda d de ia ions.
The ADHD g oup exhibi ed a mo e libe al esponse bias han he ND
g oup in ecogni ion memo y, as indica ed by be a (ß) alues (
94
=2.24,
p =0.013, Cohen’s d =0.450, Fig. 1). In addi ion, ND g oup disc imi-
na ed be e han ADHD g oup as showed by d’ (
94
=2.29, p =0.011,
Cohen’s d =0.524, Fig. 1). ADHD commi ed a highe numbe o misses
(
94
=2.16, p =0.016, Cohen’s d =0.446) and alse ala ms (FA), (
94
=
1.98, p =0.025, Cohen’s d =0.409; see able annex 2, 3).
In con as , no signi ican di e ences we e obse ed in ß be ween he
g oups in he pa e n sepa a ion index (ISP) (
94
=0.31, p =0.378,
Fig. 1), indica ing a simila conse a i e s a egy in bo h g oups. In
addi ion, ND displayed a highe d’ alue (
94
=1.52, p =0.065, Cohen’s
d =0.313, Fig. 1) due o he ewe FA, al hough his di e ence was no
s a is ically signi ican .
2.8. T ea men E ec s in ADHD
To explo e he e ec o he ea men , we u he analyzed he
disc imina ion capaci y among h ee ADHD coho s. Coho one
exhibi ed a lowe d’ compa ed o coho s wo and h ee in ecogni ion
memo y (F
2,47
=3.52, p =0.038, Cohen’s d =0.364; Fishe ’s LSD es p <
0.05, Fig. 2); howe e , no di e ences we e ound in β (F
2.47
=0.13, p =
0.879, Fig. 2), sugges ing a gene al end owa ds a libe al c i e ion
ac oss all g oups. Rega ding ISP, he coho one exhibi ed signi ican ly
lowe d’ compa ed o coho s wo and h ee (F
2,47
=6.28, p =0.003,
Cohen’s d =0.922; Fishe ’s LSD es p < 0.05, Fig. 2) due o ewe HITs
(coho 1 =70.0 %, coho 2 =82.6 % and coho 3 =82.0 %). Al hough
he ANOVA was no signi ican , speci ic di e ences in β we e ound
be ween coho one and he o he coho s acco ding o pos hoc es
(F
2,47
=2.53, p =0.090, Cohen’s d =0.628; Fishe ’s LSD es p < 0.05,
Fig. 2), his could sugges ha he e a e ends o pa e ns ha wa an
u he in es iga ion wi h a la ge sample size. Acco ding his ind,
coho one displayed a neu al c i e ion, while coho s wo and h ee
showed a end owa ds a mo e conse a i e one.
Reg ession analysis indica ed a posi i e ela ionship be ween ea -
men du a ion and ecogni ion memo y, as measu ed by he d’ alue
(F
47
=6.53, p =0.015, C =0.352, R
2
=12.43, Fig. 2), showing a
Fig. 1. Dis ibu ion o pe o mance me ics in ecogni ion memo y and pa e n
ecogni ion asks. Panels A and B illus a e he dis ibu ion o d’ and β indices,
espec i ely, o ecogni ion memo y. Panels C and D p esen he same me ics
o pa e n sepa a ion. The ADHD g oup exhibi ed lowe d’ alues (mean =
2.66, SE =0.16) compa ed o he ND g oup (mean =3.17, SE =0.14) in
ecogni ion memo y (A), indica i e o poo e disc imina ion pe o mance. In
con as (C), no signi ican di e ences in d’ we e ound be ween g oups o
pa e n disc imina ion (ADHD mean =0.92, SE =0.06; ND mean =1.08, SE =
0.07). Be a alues (β) showed a simila pa e n, wi h highe alues o he
ADHD g oup in ecogni ion memo y (B) and no signi ican di e ences in
pa e n sepa a ion (D).
F.J. Loba o-Camacho e al.
Pha macology, Biochemis y and Beha io 249 (2025) 173986
3
consis en upwa d end as he ea men ad anced, ha is, he mo e
ime unde ea men , he be e esul s in ecogni ion memo y. ß
showed simila esul s, wi h a end o conse a i e c i e ion (F
47
=
5.69, p =0.021, C =0.328, R
2
=11.01, Fig. 2). In ISP, we also ound a
signi ican co ela ion in d’ (F
47
=8.59, p =0.005, C =0.397, R
2
=
15.73, Fig. 2), and ß (F
47
=4.06, p =0.049, C =0.283, R
2
=8.11, Fig. 2),
ollowing a end simila o ha obse ed in ecogni ion memo y ask.
These indings sugges ha longe ea men du a ion could be associ-
a ed wi h imp o ed pe o mance in bo h memo y asks and esponse
s a egies.
2.9. Response ime analysis
Due o he lack o no mali y in esponse imes, we ha e used non-
Fig. 2. Pe o mance me ics by coho and ask. Panels A and B p esen d’ and β alues, espec i ely, o ecogni ion memo y ac oss h ee coho s. Panels C and D
display he same me ics o pa e n ecogni ion. Panels E, F, G, and H illus a e he eg ession models o d’ and β in ecogni ion memo y and pa e n ecogni ion,
espec i ely. Da a a e p esen ed as mean ±s anda d e o (SE).
F.J. Loba o-Camacho e al.
Pha macology, Biochemis y and Beha io 249 (2025) 173986
4
pa ame ic es s. The e o e, o compa e he dis ibu ions o wo inde-
penden g oups, he Mann-Whi ney U Tes was used, and o compa e
h ee o mo e independen g oups, he K uskal-Wallis H Tes was
employed.
To assess esponse wai ing impulsi i y, we compa ed RT be ween
ADHD and ND g oups. As expec ed, he ADHD g oup exhibi ed signi i-
can ly as e o e all esponse imes compa ed o he ND g oup (W =
2.796, p < 0.001, Cohen’s d =0.617, Table 2). This sugges s a po en ial
esponse bias in he ADHD g oup.
We u he analyzed RT be ween he coho s, examining bo h global
esponse imes and a iabili y. To es ima e he equali y be ween a i-
ances, Le ene’s es was used. He e, we ound a signi ican e ec o
coho on esponse imes. Pa icipan s in coho one displayed signi i-
can ly slowe and mo e a iable RT compa ed o coho s wo and h ee
(H =15.12, p < 0.001, Cohen’s d =0.078; Le ene’s =7.24, p < 0.001,
Table 2). This sugges s po en ial di e ences in p ocessing speed ac oss
coho s.
To unde s and unde lying esponse s a egies, we analyzed RT o
a ge , lu e, and oil s imuli sepa a ely. The ND g oup exhibi ed signi -
ican ly di e en RT o each s imulus ype (H =137.92, p < 0.001,
Cohen’s d =0.246; Fishe ’s LSD es , p =0.01; Fig. 3). This indica es a
nuanced esponse p ocess, wi h RT inc easing p og essi ely ( a ge <
lu e < oil). In con as , he ADHD g oup p esen ed signi ican ly as e
RT o a ge s imulus compa ed o lu e and oil s imuli, bu no di e -
ences be ween lu e and oil esponse ime (H =70.56, p < 0.001,
Cohen’s d =0.176, Fishe ’s LSD es p =0.01; Fig. 3). This sugges s a less
di e en ia ed esponse p ocess in he ADHD g oup, po en ially e lec -
ing impulsi i y o di icul y in dis inguishing be ween s imuli.
2.10. Age and gende esul s
We conduc ed a eg ession analysis o examine he in luence o age
on ask pe o mance wi hin he ADHD g oup. We ound no signi ican
ela ionship be ween age and ei he ISP (d’: F
47
=0.02; β: F
47
=0.01,
bo h ps >0.9) o ecogni ion memo y (d’: F
47
=3.28, p =0.08; β: F
47
=
3.21, bo h ps >0.08). In addi ion, no di e ences we e ound be ween
g oups in mean age as no ed in Table 1 (
95
=0.944, p =0.347) o
among he ADHD coho s (F
2,47
=1.73, p =0.189).
Analyses o sex di e ences g oup e ealed no signi ican di e ences
in d’ (F
3.95
=0.89, p =0.449) o ß (F
3.95
=1.14, p =0.337) in ISP.
Howe e , an in e es ing esul eme ged ega ding ecogni ion memo y.
Females in he ADHD g oup displayed signi ican ly be e ecogni ion
memo y han males (F
3.95
=4.06, p =0.009, Fishe ’s LSD Tes p < 0.05,
Cohen’s d =0.760). This di e ence appea s o be d i en by a mo e
conse a i e esponse bias in males, who exhibi ed a endency o miss
a ge s compa ed o emales (
46
=1.76, p =0.013, Cohen’s d =0.544).
3. Discussion
P ocessing de ails in ol es b ie ly ocusing on pa s o he s imuli
ha we conside essen ial (Posne e al., 2020). P e ious s udies sug-
ges s ha ina en ion in ADHD is linked o di icul ies in de ail p o-
cessing, po en ially due o inc eased dis ac ibili y (Fassbende e al.,
2009; Gumenyuk e al., 2005). In his s udy, we analyzed he abili y o
indi iduals diagnosed wi h ADHD o disc imina e be ween simila
s imuli, ocusing on a en ion o de ail h ough pa e n sepa a ion.
We expec ed he ADHD g oup would exhibi impai ed pa e n sep-
a a ion due o de ici s in de ail p ocessing. Howe e , ou indings
e ealed no signi ican di e ences be ween he ADHD and ND g oups in
pa e n sepa a ion. This inding is ele an since pa e n sepa a ion
depends on he abili y o a end and encode de ails be ween simila
objec s.
These esul s con as wi h hose om ou p e ious s udy, which
ound a pe o mance di e ence in a sample o young people wi h ADHD
in ISP compa ed o a ND con ol g oup (Loba o-Camacho e al., 2024b).
He e, we analyzed disc imina ion and esponse c i e ion in bo h ADHD
and ND samples. Despi e p e ious indings sugges ing a clea ad an age
o he ND g oup, da a ob ained in he p esen s udy poin s o simila
disc imina ion and esponse c i e ia in bo h g oups when he di icul y
o he es inc ease. This is an in e es ing esul because i could indica e
a possible ceiling e ec in ND g oup due o he complexi y o he ask.
This issue is being analyzed in dep h by ou g oup.
In he same ein, we analyzed how he du a ion o ea men in lu-
enced pa e n sepa a ion by examining pe o mance ac oss coho s. The
analysis e ealed enhanced disc imina ion in ISP as ea men du a ion
inc eased. This inding aligns wi h p e ious esea ch demons a ing he
bene icial impac o s imulan ea men on pa e n sepa a ion a e 24
mon hs o ea men (Loba o-Camacho e al., 2024b). Ou esul s, in
conjunc ion wi h hose o Mikl´
os e al., 2019 sugges ha he lack o
di e en ia ion be ween medica ed and unmedica ed child en in
dis ac ion asks may be a ibu ed o insu icien ea men du a ion.
Ex ended s imulan he apy appea s necessa y o achie e subs an ial
imp o emen s in disc imina ion be ween simila s imuli, po en ially
indica ing enhanced a en ion o de ail and educed dis ac ibili y.
On he o he hand, we also analyzed esponses o ecogni ion
memo y. Indi iduals wi h ADHD demons a ed lowe disc imina ion
capaci y on his ask. This obse a ion is consis en wi h p e ious
esea ch indica ing impai men in ecogni ion memo y ac oss bo h
e bal and objec asks wi hin his popula ion (Ande sen e al., 2013;
Loba o-Camacho and Faísca, 2024a) Addi ionally, his analysis e ealed
an in e es ing sex-based di e ence wi hin he ADHD g oup. Females
displayed g ea e disc imina ion be ween s imuli compa ed o males.
This inding is consis en wi h a ecen me a-analysis, which indica ed
ha samples wi h a highe pe cen age o women wi h ADHD exhibi
g ea e objec ecogni ion memo y (Loba o-Camacho & Luís Faísca,
2024). This could po en ially be linked o possible sex di e ences in
ADHD diagnosis, leading o po en ially di e gen symp oma ology in
emales (Ca ucci e al., 2023; Hinshaw e al., 2022; Young e al., 2020).
Likewise, he analysis e ealed ha disc imina ion in ecogni ion
memo y imp o ed no ably wi h inc easing ea men du a ion wi hin
he ADHD coho . This inding appea s o con adic p e ious esea ch
in humans, whe e a single dose o s imulan s did no imp o e objec
ecogni ion memo y (Rhodes e al., 2006). I is impo an o no e ha
some compa a i e s udies in animals sugges a po en ial de e io a ion in
ecogni ion memo y wi h p olonged s imulan s use (LeBlanc-Duchin
and Taukulis, 2009). These disc epancies could be due o se e al ac o s,
including dosage a ia ions ac oss s udies and species (Foley e al.,
2019; Ross e al., 2020; Rozenek e al., 2019; Va gas e al., 2016).
Table 2
Median esponse ime (ms) and s anda d de ia ion o each g oup (ADHD, ND) ac oss he en i e es (Global RT) and o each s imulus ype ( a ge , lu e, oil). No e ha
he ADHD g oup includes bo h he o e all mean and he speci ic sco es by ea men coho s.
Global RT Ta ge Lu e Foil
G oup median SD median SD median SD median SD
ND 2064 1336 1946 1317 2052 1328 2193 1344
ADHD 1496 1382 1409 1214 1522 1301 1552 1594
Coho 1 1511 1530 1438 1312 1549 1337 1550 1872
Coho 2 1504 1275 1433 1166 1538 1186 1561 1450
Coho 3 1440 1270 1341 1098 1488 1132 1537 1243
F.J. Loba o-Camacho e al.
Pha macology, Biochemis y and Beha io 249 (2025) 173986
5
E en hough ou indings showed imp o emen in ecogni ion
memo y, he ADHD g oup s ill pe o med signi ican ly lowe han he
no ma i e g oup. I has been no ed ha imp o emen s in objec
ecogni ion memo y may ake longe han 24 mon hs o each pe o -
mance le els simila o he no ma i e g oup (Loba o-Camacho e al.,
2024b). The e o e, some pa icipan s in ou s udy migh no ye ha e
eached hei peak ea men bene i .
3.1. Response bias
Decision-making is an execu i e unc ion ha in ol es selec ing
om mul iple op ions and conside ing hei esul s and consequences.
An al e a ion in his p ocess has been obse ed in ADHD pa ien s (G oen
e al., 2013). Ou analysis o he esponse s a egy used du ing
disc imina ion es s sugges s a end owa ds commi ing mo e misses in
he ADHD g oup han he no ma i e g oup, al hough he inclina ion was
only signi ican in ecogni ion memo y assessmen .
To analyze he e olu ion o esponse bias, we u he compa ed
esponse s a egy ac oss ea men coho s. In e es ingly, no signi ican
di e ences eme ged be ween he coho s in ecogni ion memo y ask.
This sugges s ha while ADHD may b oadly impac decision-making,
he speci ic esponse s a egies and biases employed appea o be ela-
i ely consis en . Howe e , we ound a ela ionship be ween ea men
ime and esponse bias, whe e longe ea men ime was ela ed o a
lowe numbe o misses.
Rega ding pa e n sepa a ion, we ound a di e ence be ween coho
one and coho s wo and h ee, whe e coho one pe o med he ask
wi h a g ea e end owa ds misses. In line wi h his inding, we also
ound a ela ionship be ween a longe ea men ime and a esponse
bias less o ien ed owa ds misses. In bo h cases, i seems ha he
ea men had some in luence on he esponse bias in bo h es s,
al hough i seems o be mo e e iden in pa e n sepa a ion. In e es ingly,
his ask u ned ou o be mo e cogni i ely challenging o bo h g oups,
which may make small imp o emen s mo e obse able.
While p e ious s udies sugges ha child en wi h ADHD diagnosis
may s uggle o adjus hei esponse s a egies in ega d o cogni i e
load (Se gean and an de Mee e, 1988), ou s udy o e s a di e en
pe spec i e. We ound ha he ADHD g oup exhibi ed an adjus men o
esponse bias o cogni i e load simila o ND g oup. Bo h g oups ound i
mo e di icul o disc imina e in he pa e n sepa a ion ask whe e he
esponse bias was ela ed o a end owa ds p oducing ewe misses. In
con as , disc imina ion in he ecogni ion memo y ask was be e han
in pa e n sepa a ion, wi h a esponse bias a o ing ewe alse ala ms.
In iguingly, ou analysis o esponse imes e ealed a signi ican di -
e ence: in he pa e n sepa a ion ask, he ADHD g oup was slowe in
esponding o lu e s imuli compa ed o a ge s imuli. This sugges s ha
lu e s imulus disc imina ion may pose a g ea e cogni i e challenge o
his g oup, adjus ing hei esponse ime o he ask’s di icul y
(Se gean and an de Mee e, 1988).
Wi hin he ADHD g oup, ou analysis e ealed an in e es ing sex
di e ence in esponse s a egy o he ecogni ion memo y ask. Females
exhibi ed a bias owa ds commi ing mo e alse ala ms han males,
al hough emale showed a highe ecogni ion memo y index. These da a
sugges a mo e libe al c i e ion in ecogni ion memo y. In con as ,
he e we e no signi ican di e ences in esponse la ency be ween bo h
g oups. Nei he did we ind sex di e ences in esponse s a egy o he
pa e n sepa a ion ask, whe e disc imina ion a es we e simila be-
ween males and emales.
These esul s, oge he wi h he indings in s imulus disc imina ion,
p o ide aluable insigh s in o how he e ec s o ea men on basic
Fig. 3. Cumula i e esponse ime dis ibu ions. Panels A and B display cumula i e esponse ime dis ibu ions o ADHD and neu o ypical (ND) g oups, espec i ely.
Panels C-E p esen cumula i e esponse ime dis ibu ions o he ADHD g oup ac oss a ge , lu e, and oil s imuli. Panels F
–
H depic he same dis ibu ions o he
ND g oup. * p < 0.01.
F.J. Loba o-Camacho e al.
Pha macology, Biochemis y and Beha io 249 (2025) 173986
6
cogni i e p ocesses could in luence mo e complex cogni i e unc ions,
such as decision-making. Speci ically, we obse ed ha ea men may
enhance he abili y o disc imina e be ween esponse al e na i es,
which is cen al o e ec i e decision-making. In iguingly, he ADHD
g oup adjus ed hei esponses s a egically ega ding he cogni i e load
o he ask. Howe e , we did no de ec a di ec in luence o ea men on
his speci ic esponse bias adjus men .
3.2. Response imes
Impulsi i y, de ined as he endency o espond p ema u ely, can be
exace ba ed in ADHD pa ien s (Jim´
enez-So o e al., 2020, 2022). To
s udy his aspec o impulsi i y, we analyzed RT in he samples. Ra he
han imposing a speci ic ime limi o esponses, we in o med he
pa icipan s ha once pic u es disappea ed, a new one would no be
shown un il hey made a choice. This app oach allowed us o obse e
na u al esponse ends. Ou analysis e ealed signi ican ly lowe RT in
he ADHD g oup. This inding is consis en wi h p e ious s udies whe e
child en wi h ADHD we e ound o be mode a ely as e han ND chil-
d en (Ko le e al., 2013).
As a esul o his dec ease in RT, he ADHD g oup showed a highe
e o a e han he ND g oup. In gene al, he ADHD g oup esponded
be o e he disappea ance o he s imulus, indica ing has e in hei e-
sponses, con a y o he ND g oup. Ou esul s a e in line wi h p e ious
wo k, such as Van Dessel e al. (2019), who ound heigh ened wai ing
impulsi i y and educed inhibi o y con ol in child en wi h ADHD
compa ed o a no ma i e sample. Thei s udy linked wai ing impulsi i y
o pa en - epo ed a ings o hype ac i i y/impulsi i y and was a sig-
ni ican p edic o o ADHD symp oma ology s a us (Van Dessel e al.,
2019).
To explo e he e olu ion be ween he coho s, we examined he RT
and i s a iabili y in hei esponses. RT a iabili y has been p oposed as
an unde lying ai in ADHD (Ko le e al., 2013). I has been a gued o
e lec a subse o abno mally slow esponses du ing asks, exhibi ing
inc eased RT a iabili y ac oss a wide ange o asks, including beha -
io al inhibi ion (Ko le e al., 2013). We ound a slowe esponse ime in
coho one, al hough he e ec size was small. Howe e , we ound less
a iabili y in esponse imes in coho s wo and h ee associa ed wi h a
dec ease o slow esponses. This could be due o di icul y in inhibi ing
inapp op ia e esponses, causing hem o ake longe o gi e co ec and
app op ia e esponses (G andjean e al., 2021). In suppo o his iew,
coho s wo and h ee made a lowe pe cen age o e o s in hei e-
sponses. This dec ease in e o s likely e lec s he be e disc imina ion
be ween s imuli ound in he coho s ha ecei ed longe ea men .
The e o e, ou indings sugges ha s imulan ea men migh ha e
educed di e ences be ween he ADHD and ND g oups, e en hough i
does no seem o add ess wai ing impulsi i y as e ec i ely as basic
cogni i e p ocesses.
3.3. Response p ocess
The analysis o RT in he ND g oup e ealed a clea dis inc ion be-
ween he h ee s imuli. This a ia ion could be ela ed o a se ial
analysis p ocess based on he s imuli encoded du ing lea ning.
Following a ch onological o de , he lowes RT was obse ed o a ge
s imuli explici ly p esen ed du ing lea ning. In case o di ec ecogni ion
no being success ul, he RT inc eased as pa icipan s po en ially
analyzed he simila i y o amilia i y o he s imulus o p e iously
encoded images, po en ially leading o he selec ion o simila lu es.
Finally, he highes RT eme ged o oils, sugges ing classi ica ion as
en i ely no el s imuli. This pa e n aligns wi h he Yonelinas e al.
(2010) dual-p ocess model, whe e ecollec ion se es as a high-
h eshold p ocess o e ie ing speci ic de ails, and amilia i y ac s as
a con inuous a iable guiding decision when ecollec ion ails.
Rega ding he pe o mance o he ADHD g oup, ou analysis
e ealed a signi ican di e ence in RT o a ge s imuli compa ed o lu e
and oil s imuli. This con as wi h he no ma i e g oup, whe e di e -
ences we e obse ed in he RT o he lu e and oil s imuli. This
disc epancy could be due o di e en s imulus p ocessing in he ADHD
g oup. While he ini ial eco e y p ocess may be simila o he no ma-
i e g oup (as seen in a ge eco e y), lu es and oils migh be subse-
quen ly managed in pa allel o ca ego ized wi hin he same ca ego y.
The possibili y o p ocessing in pa allel, combined wi h sho e RT
and he simila pe o mance obse ed in he ND g oup, is consis en
wi h ou indings in he pa e n sepa a ion ask. Con e sely, ca ego iz-
ing di e en s imuli as simila could indica e an in e e ence p ocess,
esul ing in lowe pe o mance compa ed o he no ma i e g oup, as
seen in he ecogni ion memo y ask. These esul s sugges po en ial
di e ences in unde lying b ain mechanisms o s imulus managemen
be ween he g oups, suppo ing he possibili y o neu al ne wo k a i-
a ions in indi iduals wi h ADHD and ND samples (Kon ad and Eickho ,
2010; Yoo e al., 2018).
Despi e a ho ough sea ch, we ound a lack o s udies aimed a
analyzing his issue. I is impe a i e o expand his ype o analysis o
ully unde s and di e ences in in o ma ion p ocessing wi hin he ADHD
popula ion.
4. Conclusions
Ou s udy e ealed se e al key indings ega ding he cogni i e
p ocesses in ADHD compa ed o a ND sample. O e all, ou indings
indica e di e en in o ma ion p ocessing pa e ns in indi iduals wi h
ADHD compa ed o ND con ols. While ADHD pa icipan s demon-
s a ed de ici s in ecogni ion memo y, a en ion o de ail and a en-
dency owa ds impulsi e esponding, s imulan ea men appea ed o
amelio a e some cogni i e di icul ies, pa icula ly in imp o ing
disc imina ion abili ies and educing e o s. Howe e , u he in es i-
ga ion is wa an ed o ully unde s and he unde lying mechanisms and
o de elop mo e a ge ed in e en ions o ADHD.
Open p ac ices s a emen
The da ase s gene a ed du ing and analyzed du ing he cu en s udy
a e a ailable om he co esponding au ho upon easonable eques .
CRediT au ho ship con ibu ion s a emen
F ancisco Jos´
e Loba o-Camacho: W i ing – e iew & edi ing,
W i ing – o iginal d a , Me hodology, In es iga ion, Fo mal analysis,
Da a cu a ion, Concep ualiza ion. Juan Ped o Va gas: W i ing – e iew
& edi ing, Valida ion, Supe ision, P ojec adminis a ion, Funding
acquisi ion. Juan Ca los L´
opez: W i ing – e iew & edi ing, Valida ion,
Supe ision, Resou ces, P ojec adminis a ion, Funding acquisi ion.
In o med consen s a emen
In o med consen was ob ained om all subjec s in ol ed in he
s udy.
Ins i u ional e iew boa d s a emen
The s udy was app o ed by he Comi ´
e de ´
E ica de la In es igaci´
on de
la Uni e sidad de Se illa, dependen Comi ´
e Coo dinado de ´
E ica de la
In es igaci´
on Biom´
edica de Andalucía, Jun a de Andalucía (Spain) wi h
he code (2099-N22).
Funding
Gobie no de Espa˜
na. Minis e io de Ciencia e Inno aci´
on y Uni-
e sidades: PID2019-110739GB-I00/AEI/10.13039/501100011033 y
PID2023-149901NB-I00.
F.J. Loba o-Camacho e al.
Pha macology, Biochemis y and Beha io 249 (2025) 173986
7
Decla a ion o compe ing in e es
The au ho s ha e no hing o disclose.
Acknowledgmen s
To he Ai e Lib e Associa ion o Families wi h ADHD o Huel a (Spain)
and i s he apy and manage eams o hei sel less collabo a ion in his
wo k and hei signi ican con ibu ion o imp o ing he quali y o li e o
people diagnosed wi h ADHD.
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