The role of executive function for differentiating symptoms of ADHD in preschoolers

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder associated with broad functional impairments in children. As a critical cognitive ability, executive function (EF) undergoes rapid development during preschool years. This study investigates the discriminative role of EF in identifying ADHD symptoms amid challenges in early assessment. A cohort of 141 preschoolers aged 4–5 years with ADHD was assessed with a battery of standardized instruments: the Behavior Rating Inventory of Executive Function-Preschool Edition (BRIEF-P) for EF, the Developmental Coordination Disorder Questionnaire-Chinese Version (DCDQ-C) for motor coordination, the Swanson, Nolan and Pelham, Version-IV Scale (SNAP-IV) for ADHD symptoms, the Parents’ Evaluation on Preschooler’s Social Skills (PEOPSS) and the Early Childhood Communication Interest Questionnaire. Analyses using correlation tests, multiple linear regression, and receiver operating characteristic (ROC) curves revealed that ADHD symptoms were significantly associated with EF, motor coordination, social skills, and communication interests. ROC analyses identified differential links between specific EF components and symptom domains: Working memory strongly discriminated attention deficit (AD) (AUC = 0.854), as did the Inhibitory Self-Control Index (ISCI) for oppositional defiant symptoms (AUC = 0.852), while Plan/Organize demonstrated a more moderate capacity to discriminate hyperactivity/impulsivity (AUC = 0.719). Regression models confirmed EF as a robust predictor of ADHD symptoms. These results indicate that EF metrics can effectively distinguish ADHD symptoms in Chinese preschoolers.