How Does Adult Temperament Relate to ADHD Symptom Domains? Testing the Dual-Pathway Model

This is the authors' abstract. We don't add key points for this paper.

Object: Temperament provides a valuable framework for understanding ADHD across the lifespan, as extreme temperamental traits are considered etiological risk factors. The dual-pathway model links specific temperamental traits to ADHD symptom domains: elevated reactive traits, surgency and negative affect, to hyperactivity/impulsivity, and a low regulatory trait, effortful control, to inattention. Method: One hundred fifty-eight adults (79 with clinical diagnoses of ADHD and 79 controls) filled in the Adult Temperament Questionnaire. Consistent with a compensatory extension of the dual-pathway model, it was hypothesized that effortful control would moderate the effects of reactive traits (surgency/negative affect) on hyperactive/impulsive symptoms and influence both ADHD symptom domains. For exploratory purposes, orienting sensitivity, an adult temperament factor related to perceptual sensitivity, was included in the analyses. Results: Binary logistic regression identified lower effortful control as the strongest predictor of an ADHD diagnosis. Negative affect had a significant but small effect, while surgency and orienting sensitivity were non-significant. Two hierarchical regressions were performed for self-rated symptoms of hyperactivity/impulsivity and inattention. Consistent with a compensatory model, effortful control was significantly related to symptom expression in both ADHD symptom domains. Contrary to expectations, surgency did not explain variance in hyperactivity/impulsivity, and the effect of negative affect was strongly reduced, after effortful control was added to the model. Effortful control did not moderate the effects of surgency and negative affect. Conclusion: These findings challenge the dual-pathway model and highlight self-regulation deficits over reactive traits in sustaining ADHD in adulthood. They underscore the value of temperament-based approaches for refining diagnosis and developing targeted interventions for adult ADHD.