The mediating role of executive functioning on school achievement in children with attention-deficit/hyperactivity disorder: a population-based study

*Correspondence: [e-mail].

Abstract

Background: Executive dysfunction plays a central role in Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms and impairments. However, little is known about its mediating effect on school achievement in this vulnerable group.

Objective: Herein, we take advantage of a large populational sample of children to examine the impact of ADHD on school achievement as mediated by executive functioning (EF).

Methods: Population-based survey, where parents and teachers completed validated questionnaires evaluating sociodemographic, mental health, and school achievement data. Parents fulfilled the Executive Function Inventory for Children and Adolescents. ADHD was ascertained according to DSM-5 criteria. Mediating models (bootstrapping iterations) were applied to assess: 1) total effect of ADHD on school achievement; 2) direct effect of ADHD controlled by EF score on school achievement. The mediating role was derived from the difference of total and direct effects.

Results: Consents and analyzable data were obtained from 3,205 children (93.9% of the target sample), 48% females, aged 5-12 years (M=8, SD=1.96). 2.5% children met criteria for ADHD showing increased risk for lower school achievement compared to non-ADHD controls (p<0.001). ADHD predicted poorer school achievement (total effect, β=-1.4, p<0.01), and EF significantly mediated the impact of ADHD on school achievement (direct effect, β=-0.83, p<0.01).

Conclusion: Executive functioning plays a mediating role in the impact of ADHD on school achievement. Children with ADHD and better EF are less likely to have low school achievement. The present findings establish plausibility to further research investigating the effects of EF interventions on school achievement in this vulnerable group.

 

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Artikel online veröffentlicht:
12. Mai 2025