Identifying Transdiagnostic Cognitive Phenotypes in Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) via Cluster Analysis: The Contribution of Executive Function and Social Cognition Profiles

Mohammad Reza Yekta¹ Salar Faramarzi²

1) Postdoctoral Researcher, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
2) Professor in Department of Psychology and Education of Children with Special Needs, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran Email:

IOI Code : ABFK-ACZFHZ
Publication : The third international conference on new researches in management, law, humanities and entrepreneurship(icmlhe.ir)
Abstract :
    Attention-deficit/hyperactivity disorder (ADHD) in adulthood is associated with considerable cognitive heterogeneity, the understanding of which can facilitate personalized diagnosis and treatment. The present study aimed to identify transdiagnostic cognitive phenotypes in adults with ADHD and to examine the role of executive function and social cognition profiles using cluster analysis. This study was fundamental–applied in purpose and descriptive–correlational (cross-sectional) in design. The statistical population consisted of adults aged 18 to 50 years residing in Isfahan, Iran, who had been referred to psychiatric clinics and counseling centers with a diagnosis of ADHD based on DSM-5-TR criteria during the first half of 1405 (2026). A purposive convenience sample of 238 participants (142 men, 96 women) was selected. Research instruments included the Adult ADHD Self-Report Scale (ASRS), the Structured Clinical Interview for DSM-5 (SCID-5-CV and SCID-5-PD), neuropsychological tests of executive functions (WCST, Stroop, TOL, and Digit Span), and social cognition measures (RMET, EQ, and FERT). Data were analyzed using Ward s hierarchical cluster analysis, K-means clustering, MANOVA, and chi-square tests in SPSS-27 and R-4.3.1. Results revealed three distinct cognitive phenotypes: a phenotype with cold executive dysfunction (37.4%), a phenotype with social cognition and hot executive dysfunction (34.5%), and a phenotype with a relatively normal cognitive profile (28.1%). The social cognition deficit phenotype showed the highest levels of depression, anxiety, emotion regulation difficulties, and comorbid borderline personality disorder, along with the lowest quality of life and occupational functioning. The findings indicate that adult ADHD is a heterogeneous condition comprising at least three distinct cognitive phenotypes, and that social cognition deficits—as a less recognized dimension—play an important role in explaining its clinical burden and heterogeneity. These results support the transdiagnostic approach and emphasize the necessity of incorporating social cognition and emotion regulation assessment into the diagnostic process and the design of personalized interventions.

Keywords : attention deficit/hyperactivity disorder (adhd) cognitive phenotype cluster analysis executive functions social cognition transdiagnostic approach adults