Do executive functions differentiate Iranian children with attention-deficit/hyperactivity disorder with and without comorbid obesity?

This article focuses on comparing executive function (EF) profiles between Iranian children aged 8–13 with attention-deficit/hyperactivity disorder (ADHD) with and without comorbid obesity. Using a battery of culturally adapted performance-based "cool" EF tasks (e.g., working memory, cognitive flexibility, response inhibition) and parent-reported measures of "hot" EF (future-oriented cognition such as delay of gratification), the study found a gradient of cognitive performance: typically developing children performed best, followed by children with ADHD without obesity, and then children with ADHD and obesity who showed the greatest impairments. Specifically, children with ADHD and obesity exhibited significantly poorer working memory, cognitive flexibility, inhibitory control, attentional bias, prospective memory, episodic foresight, and delay of gratification compared to those with ADHD alone. These findings suggest that obesity in children with ADHD is associated with broader deficits in both "cool" and "hot" executive functions, highlighting the need for integrated treatment approaches addressing these cognitive domains.