Abstract
Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by
inattention, hyperactivity, and impulsivity. A substantial proportion of individuals with
ADHD also exhibit symptoms of Cognitive Disengagement Syndrome (CDS), which
may further impair executive functions.
Purpose: This study aimed to examine the prevalence of comorbid ADHD and CDS
(ADHD+) among adults in Bushehr, Iran, and to compare executive functioning between students with ADHD+ and healthy controls. Gender-based prevalence patterns
were also explored.
Methods: A total of 690 university students were screened using the Barkley Adult
ADHD Rating Scale-IV (BAARS-IV). ADHD and CDS diagnoses were confirmed via
structured clinical interviews. From this sample, 43 adults with comorbid ADHD+CDS
and 53 matched healthy controls completed three standardized executive function
tasks: the Stroop Color-Word Test (SCWT), Wisconsin Card Sorting Test (WCST),
and Tower of London Test (TOL).
Results: The prevalence of comorbid ADHD and CDS (ADHD+) was 25.15% across
the total sample (N = 690), whereas 41.3% of those diagnosed with ADHD also met
criteria for CDS; however MANOVA revealed significant group differences across
ADHD symptom domains based on CDS comorbidity (Wilk’s λ = .48, F = 184.21, p <
.001, η2 = .52). Significant effects were observed for attentional problems (F = 103.12,
p < .001, η2 = .13), overall ADHD symptoms (F = 65.26, p < .001, η2 = .09), and
combined ADHD + scores (F = 259.43, p < .001, η2 = .27). Smaller effects were found
for hyperactivity and impulsivity (η2 = .01).
Conclusions: Students with ADHD and comorbid CDS exhibit specific cognitive
deficits, particularly in planning and attentional control, that should be considered in
designing cognitive rehabilitation programs. These findings may inform culturally appropriate intervention strategies in Iran, such as cognitive rehabilitation programs
targeting attentional control and planning deficits among university stud