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Rev Neurol. 2004 Feb;38 Suppl 1:S97-102.

[Cognitive flexibility, an additional symptom of attention deficit hyperactivity disorder. Is it a therapeutically predictive element?].

[Article in Spanish]

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Centro de Neurodesarrollo Interdisciplinar, Valencia, EspaƱa.



Cognitive flexibility is a capability acquired during infancy that can be evaluated from the age of 8 onwards. This executive function can affect patients with dorsolateral frontal lesions. Involvement of this function in some children with attention deficit hyperactivity disorder (ADHD) would point to an additional disorder.


The objective of this study was to report on the involvement of cognitive flexibility in patients with ADHD from the age of 8 years onwards, to establish a correlation with the progressive phenomenon in its development, and to relate the findings from the study of cognitive flexibility with those of the attentional function.


A group of 50 children diagnosed as suffering from ADHD (8 21 years old) and 50 normal children were evaluated. The same subjects were submitted to a study of their attentional functions, their inhibitory control mechanisms as well as their cognitive flexibility.


At least 38% of the patients studied showed involvement of cognitive flexibility. No statistically significant relation was observed when data were linked to the age variable, which could point to the absence of the maturation factor, unlike the results observed in the case of sustained attention. Patients with poor cognitive flexibility also present disorders involving attentional discrimination, the control of impulses and interference control.


The group with cognitive rigidity as a symptom added to the attentional disorder could correspond to a complex subtype that does not respond so successfully to stimulants. Consequently, cognitive flexibility studies could reflect an indicator for selecting the type of pharmacological treatment to be employed.

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