2026 ECNP Congress

PS03-3265

Executive functioning in adolescents with attention-deficit/hyperactivity disorder and borderline personality traits: a comparative study

Müge Mutlu — B. Kirmizi Ozsoy · Silivri State Hospital, Child and Adolescent Psychiatry, Istanbul, Türkiye

2026 ECNP Congress

Background

Adolescence is a neurodevelopmental period marked by an imbalance between early limbic maturation and ongoing prefrontal development, which may contribute to increased emotional reactivity and reduced regulatory control (1). Research consistently demonstrates that executive functioning difficulties are prominent in adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) and borderline personality traits (BPTs) (2-3). Executive functioning processes, including inhibitory control, cognitive flexibility, and working memory, are critical for adaptive behavior and goal-directed functioning. In ADHD, executive functioning difficulties—particularly in attention regulation, inhibitory control, and processing speed—are more closely associated with inattentive symptoms than with hyperactive-impulsive features (2). Similarly, individuals with BPTs exhibit alterations in executive functioning compared to healthy controls, although these difficulties may be more selective and context-dependent (3). However, studies directly comparing these profiles within adolescent populations remain limited (4). This study aimed to compare the neuropsychological profiles of adolescents with ADHD, those with BPTs, and healthy controls, with a specific focus on executive functioning.

Methods

In this cross-sectional study, adolescents aged 14–19 years were recruited from a child and adolescent psychiatry outpatient clinic. Following a DSM-5–based clinical interview, ADHD diagnoses were established using the K-SADS-PL, while BPTs were operationalized using a validated self-report scale (cut-off ≥69). Executive functions were assessed using the Stroop Test, evaluating inhibitory control and processing speed, and the Wisconsin Card Sorting Test, assessing cognitive flexibility and perseverative responding. Group differences were examined using appropriate parametric and non-parametric analyses, and regression-based models were planned to explore associations among cognitive and clinical variables.

Results

A total of 154 adolescents were included (81 girls, 73 boys):50 controls (29 girls, 21 boys), 54 with BPTs (29 girls, 25 boys), and 50 with ADHD (23 girls, 27 boys). Sex distribution did not differ between groups (p=0.476). Groups differed in academic performance (p=0.023), maternal education (p=0.036), and parental marital status (p=0.026), with poorer academic outcomes in the BPT group.Both clinical groups showed significantly poorer executive functioning than controls, including reduced set-shifting and increased perseveration (p<0.001), with comparable difficulties in cognitive flexibility. Executive performance was lowest in the ADHD group, particularly in inhibition and processing speed (Stroop, p<0.001), whereas the BPTs group showed intermediate performance but relatively higher error rates. Additionally, the ADHD group demonstrated increased self-correction behavior, suggesting preserved error awareness despite reduced inhibitory control. In addition, both clinical groups showed reduced category completion and lower conceptual response rates,suggesting impaired cognitive flexibility (p<0.001)

Conclusions

These findings support the presence of both shared and disorder-specific patterns of executive functioning difficulties in ADHD and BPTs during adolescence. Rather than reflecting isolated deficits, these patterns may represent differential cognitive-emotional processing styles within a developmental framework. Clinically, distinguishing these profiles may inform more targeted assessment and intervention strategies. Longitudinal studies are needed to clarify their clinical significance and developmental trajectories.

References

  1. Casey, B.J., Jones, R.M. and Hare, T.A. (2008), The Adolescent Brain. Annals of the New York Academy of Sciences, 1124: 111-126. https://doi.org/10.1196/annals.1440.010
  2. Martel, M. M., Nikolas, M., & Nigg, J. T. (2007). Executive function in adolescents with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 46(11), 1437–1444. https://doi.org/10.1097/chi.0b013e31814cf953
  3. Kalpakci, A., Ha, C., and Sharp, C. (2018) Differential relations of executive functioning to borderline personality disorder presentations in adolescents. Personality and Mental Health, 12: 93–106. doi: 10.1002/pmh.1410.
  4. LAMPE, K., KONRAD, K., KROENER, S., FAST, K., KUNERT, H. J., & HERPERTZ, S. C. (2007). Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder. Psychological Medicine, 37(12), 1717–1729. doi:10.1017/S0033291707000517