3.17 The Impact of Executive Functioning Deficit on Illness Severity in Patients With an ADHD Diagnosis: A Real-World Data Study

Emily OC Palmer, Guruprabha Guruswamy, Matthew Valko, Kira Griffiths, Rashmi Patel, Scott H. Kollins

Research output: Contribution to journalMeeting abstractpeer-review


Executive functioning (EF) is a multifaceted neuropsychological construct that allows individuals to engage in goal-directed and novel problem-solving behaviors. EF deficits have been identified in a subgroup of patients with ADHD. Heterogeneity in peer, family, and academic functioning among individuals with ADHD has been related to EF performance. Electronic health record (EHR) data captures the presentation of patients with ADHD in a real-world clinical setting and is therefore well suited to study the impact of EF deficits on ADHD illness severity. This study aims to examine the differences between baseline Clinical Global Impression-Severity (CGI-S) scores of patients with ADHD EF deficits compared with patients with ADHD without EF deficits.

De-identified EHR data from across 25 US mental healthcare providers over a period of 22 years (1999-2021) was used. A retrospective cohort analysis was conducted using Holmusk’s NeuroBlu platform. Patients with a diagnosis of ADHD (ICD-9: 314.00, 314.01; ICD-10: F90.0, F90.1, F90.2, F90.8, and F90.9), a record of CGI-S within 14 days of diagnosis, and recorded Mental Status Examination (MSE) information were included. Clinical information in the free text of the MSE was captured using natural language processing (NLP) techniques. Patients were categorized into subgroups depending on the presence or absence of any EF deficit symptoms. A between-group comparative analysis was conducted using Welch’s 2-sided t test to evaluate the difference in baseline CGI-S score between patients with EF deficit compared with those without.

Of the total cohort (n = 31,429; age = 17.8 Mean [13.0 SD]; 62.0% males, 59.9% White, 52.3% not Hispanic or Latino), 3.1% (n = 974) had clinically documented EF deficits. Those with EF had higher CGI-S scores at baseline (4.7 Mean [1.0 SD]) compared with those without EF (4.4 Mean [1.0 SD]; p < .001). The average age of diagnosis was also younger for those with EF (16.9 [12.6] years) than those without EF (17.8 [13.0] years; p = .018).

Results indicate that EF deficits are associated with worse illness severity scores for patients with ADHD. Identifying this subgroup may enhance the understanding of functional impairments and subsequently inform targeted treatment pathways.
Original languageEnglish
Pages (from-to)S233
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number10
Publication statusPublished - 1 Oct 2022


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