What question did this study set out to answer?

The study aims to investigate neurocognitive differences across ADHD presentations using digital assessments.

March 13, 2026

Neurocognitive overlap across DSM-5-TR presentations in pediatric ADHD under digital assessment

Key Points

The study aims to investigate neurocognitive differences across ADHD presentations using digital assessments.
Examiner-supervised digital assessment with CNS Vital Signs battery
Sample of children aged 7-12 diagnosed with ADHD
Applied Kruskal-Wallis tests and Bayesian ANOVA for analysis
Conducted equivalence testing to assess differences among presentations
Utilized unsupervised clustering to identify performance profiles.
No significant neurocognitive differences were found among ADHD presentations after adjustment (all p > 0.980)
Bayesian analysis favored models without presentation as a factor (BF_inclusion = 0.005-0.011)
Observed differences were negligible, with the maximum effect size (d) of 0.25
Unsupervised clustering revealed two performance profiles without relying on DSM-5-TR labels
Findings support the idea of neurocognitive overlap in children with ADHD under standardized testing.

Abstract

We examined whether DSM-5-TR ADHD presentations (inattentive, hyperactive/impulsive, combined) exhibit meaningful neurocognitive differences under examiner-supervised digital assessment. Children with ADHD (N = 193; 7-12 years) completed the CNS Vital Signs battery following diagnostic reconfirmation and stimulant washout; presentation specifiers were derived from parent SNAP-IV ratings. Ten age-normed domains were analyzed using Kruskal-Wallis tests with false discovery rate control (q =. 05), Bayesian ANOVA, and equivalence testing (TOST; d = ±0. 30). No domain differed by presentation after correction (all FDR-adjusted p values =. 980; ε2 ≤ 0. 015). Bayesian factors favored models excluding the presentation factor (BFᵢnclusion = 0. 005-0. 011). Observed differences were small (max d = 0. 25) and fell within prespecified equivalence bounds, although TOST did not reach p <. 05 for strict equivalence confirmation. Multivariately, presentation labels explained negligible variance. In contrast, unsupervised clustering identified two "Average" and "Low" performance profiles that were independent of DSM-5-TR labels. Results support substantial neurocognitive overlap across presentations under standardized testing conditions. Data-driven profiles provided a complementary, descriptive framework for characterizing heterogeneity to inform educational planning alongside symptom reports. Findings should be interpreted in light of mono-informant presentation assignment and potential underdetection of comorbidities.

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