Inter-relationships between executive functions and functional impairments among children with ADHD: findings from a network perspective.

Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently linked to functional impairments and deficits in executive functioning. This study investigated inter-relationships between executive functions and functional impairments among children with ADHD from a network analysis perspective to identify key domains for targeted intervention research. Children with ADHD, diagnosed using a semi-structured interview, were recruited from a pediatric hospital in China. Executive functions were assessed using the Behavior Rating Inventory of Executive Function - Parent Form (BRIEF). Functional impairments were measured using the Weiss Functional Impairment Scale-Parent Form (WFIRS-P). Network analysis was performed to examine interactions between executive functions and functional impairments, identifying central and bridge nodes through Expected Influence (EI) and bridge EI indices. Of the 225 participating children with ADHD, functional impairments ranged from 0.4% (95% CI: 0.0%, 1.3%) for risky behavior to 15.1% (95% CI: 10.4%, 19.8%) for self-concept. Network analysis revealed executive functions of "Monitoring" (EI = 1.11) and "Planning" (EI = 1.07) had the highest centrality values and were the most influential domains in the network model. The most influential bridge nodes linking executive function and functional impairment communities were impairments related to "Family" (bridge EI = 0.41) and the executive function, "Inhibition" (bridge EI = 0.38). This study highlighted the most influential central and bridge domains within a network model of executive functions and functional impairments among children with ADHD. Findings provide plausible hypotheses for risk factors and targeted interventions. Future research should use longitudinal designs and objective assessments to evaluate our findings further.