Evidence map›Paper›PMID 42534999›Full record

ArticleFrontiers in psychiatry2026

ADHD as a disorder of operational capacity: a buffered-state framework for sustained engagement instability.

Tianlai Tang, Christine Dong

Abstract read
In one paragraph

Article in Frontiers in psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors.

Tianlai TangNashville Brain Institute, Nashville, TN, United States.
Christine DongNashville Brain Institute, Nashville, TN, United States.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is commonly conceptualized as a disorder of executive dysfunction or impaired motivation. In clinical practice, however, many individuals with ADHD describe a different core difficulty: they can initiate tasks appropriately, understand goals, and exert effort, yet struggle to remain engaged as time-on-task and internal strain accumulate. These failures are often abrupt, ego-dystonic, and strongly context-dependent, posing challenges for models based solely on static deficits or gradual depletion. Building on this phenomenology, we propose a constraint-level framework that conceptualizes ADHD as a disorder of operational capacity-the finite tolerance for sustaining stable mental engagement under cumulative cognitive and emotional demand. Within this framework, sustained engagement is modeled as a buffered state that remains stable while cumulative load is within tolerance but becomes increasingly fragile near saturation and may undergo nonlinear collapse into disengagement. We formalize this governing constraint as Operational Economy (OE)-a regulatory, not energetic, constraint principle-and describe a pre-volitional Global Switching Framework (GSF) that mediates rapid state transitions once engagement stability is exceeded. This formulation integrates and extends cognitive-energetic and state-regulation accounts while explicitly differentiating the OE/GSF framework from these predecessors by its emphasis on threshold-dependent dynamics, bounded tolerance, and asymmetric re-engagement. This framework offers a coherent account of clinical features such as intact initial performance with late-stage disengagement, pronounced time-on-task effects, and context-dependent hyperfocus. The framework generates falsifiable predictions regarding sensitivity to cumulative demand, stress-related acceleration of disengagement, pharmacological effects that preferentially extend engagement endurance rather than normalize peak executive performance, and individual differences across ADHD subtypes and comorbid presentations. These predictions are consistent with existing empirical findings on time-dependent variability in ADHD and provide a basis for future experimental validation.

Indexed as

ADHDaffective dysregulationengagement instabilityexecutive functionmetastabilityoperational capacitysustained attention

Identifiers

PMID42534999
PMCPMC13422426

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.