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Psychiatry Investig > Volume 20(9); 2023 > Article
Psychiatry Investigation 2023;20(9):789-798.
DOI:    Published online September 19, 2023.
The Clinical Manifestation, Executive Dysfunction, and Caregiver Strain in Subthreshold Attention-Deficit/Hyperactivity Disorder
Yajing Tang1,2  , Sunwei Qiu1,2  , Haimei Li1,2  , Feifei Si1,2  , Mengjie Zhao1,2  , Min Dong1,2  , Meirong Pan1,2  , Xinxin Yue1,2  , Lu Liu1,2  , Qiujin Qian1,2  , Yufeng Wang1,2 
1Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
2NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
Correspondence: Lu Liu ,Tel: +86-10-62723701, Fax: +86-10-62070258, Email:
Correspondence: Qiujin Qian ,Tel: +86-10-62723701, Fax: +86-10-62070258, Email:
Received: March 10, 2023   Revised: May 22, 2023   Accepted: June 7, 2023   Published online: September 19, 2023
Subthreshold attention-deficit/hyperactivity disorder (ADHD) has been suggested to be a “morbid condition” which also needs medical attention.
The present study recruited 89 children with subthreshold ADHD (sADHD), 115 children with diagnosed ADHD (cADHD), and 79 healthy controls (HC) to explore the clinical manifestation, executive functions (EFs) of sADHD, and the caregiver strain. The clinical manifestation was evaluated through clinical interviews and parent-reports. Executive functions were assessed both experimentally and ecologically. Caregiver strain was measured by a parent-reported questionnaire.
For the clinical manifestation, both sADHD and cADHD indicated impairments when compared with HC. The comorbidities and the scaled symptoms indicated that the externalizing behaviors were relatively less serious in sADHD than cADHD, whereas the internalizing behaviors between two groups were comparable. For ecological EFs, sADHD scored between cADHD and HC in inhibition and working memory. For experimental EFs, sADHD was comparable to cADHD in inhibition, shifting, and was worse than cADHD in verbal working memory. For the caregiver strain, all scores of sADHD were between that in cADHD and that in HC.
Our present findings supported the suggestion of subthreshold ADHD as “morbid condition,” which should be treated with caution in clinical practice, especially for the internalizing behaviors and some key components of EFs.
Key words   Attention-deficit/hyperactivity disorder; Subthreshold; Executive function; Caregiver


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