From early risk via cognitive functioning to ADHD phenotype: A longitudinal study of boys at familial risk for ADHD

Tzlil Einziger, Yael Zilberman-Hayun, Naama Atzaba-Poria, Judith G. Auerbach, Andrea Berger

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


We examined the interplay between familial risk and the quality of the home environment and the intermediate role of cognitive functioning in the development of attention-deficit hyperactivity disorder (ADHD). Participants were 99 boys and their parents (M age = 7.34 years, SD = 0.23), who have been followed longitudinally since birth; 62 participants were followed until adolescence (M age = 13.5 years, SD = 0.95). We found that differential susceptibility to home environment in early childhood predicted the cognitive functioning (decreased executive function [EF] and increased intrasubject variability [ISV]) at elementary-school age. Specifically, in a lower quality home environment, those at high familial risk showed poor cognitive functioning (i.e., low EF and high ISV) at elementary-school age but under a supportive environment showed high cognitive functioning (i.e., high EF and low ISV), outperforming their peers at low familial risk. Moreover, child EF, but not ISV, was involved in a developmental path leading to an ADHD phenotype; it was found to mediate the relation between the early risk level (i.e., the interaction between familial risk and home environment) and child ADHD symptoms. A preliminary analysis suggests that EF may have a longitudinal effect on ADHD symptoms in adolescence; after controlling for the level of symptoms at elementary-school age, children with low levels of EF showed a significant increase in their symptoms over time. In general, our results propose a plausible mechanism that explains how the familial risk for ADHD could be translated into actual symptoms among children, at least in the case of boys.

Original languageEnglish
Pages (from-to)178-190
Number of pages13
JournalEarly Childhood Research Quarterly
StatePublished - 1 Oct 2021


  • ADHD
  • cognitive functioning
  • differential susceptibility
  • executive functions
  • intrasubject variability

ASJC Scopus subject areas

  • Education
  • Developmental and Educational Psychology
  • Sociology and Political Science


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