To determine the metacognitive deficits and behavioural and emotional regulation deficits among a group of children undergoing treatment for ADHD and to compare these with the hyperactivity/inattentive and behavioural assessments which contributed to the diagnosis.

Children and adolescents referred for ADHD assessment to a community Child & Adolescent Mental Health Service were assessed using clinical assessment, SNAP-IV, FTF and BRIEF rating scales. Comorbidities were assessed using clinical assessment and screened using the FTF. Clinical assessment included interview of parents, relatives and relevant school supervisors. The BRIEF scale was used to advise on specific executive function difficulties.

A total of 25 children and adolescents had complete assessments as part of routine clinical practice. There were particular groups which demonstrated elevated behavioural regulation difficulties; in the group with higher metacognition scores, groups were identified that had higher initiation and working memory deficits, higher planning and organisational deficits, or a mixture of all 5 items being elevated.

It is advantageous to complete an executive function assessment as part of ADHD assessment in clinical practice as it allows more detailed management advice to be given to teachers and support/special needs teachers and parents. It may also demonstrate successful patient-specific indicators of treatment response and outcome measures among those children who have high ADHD-related executive function deficits but whose core ADHD Hyperactive/Impulsive symptoms remain highly rated.