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The Nature of Executive Function (EF) Deficits in Daily Life Activities in Adults with ADHD and Their Relationship to Performance on EF Tests

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Abstract

Although attention-deficit/hyperactivity disorder (ADHD) is believed to impair EF, research using EF tests shows such deficits exist in only a minority of those with ADHD. This study hypothesized that this disparity is largely due to the low ecological validity of these EF tests. A 91-item rating scale of EF was constructed based on EF theories and found to represent 5 underlying dimensions: Self-Management to Time, Self-Organization/Problem-Solving, Self-Discipline, Self-Motivation, and Self-Activation/Concentration. Three groups were compared on these scales: Adults with ADHD (N = 146), Clinical control adults not diagnosed with ADHD (N = 97), and a Community control group (N = 109). The ADHD group had more severe EF ratings than did the Clinical group and Community control groups on all 5 scales using both self and other-reported versions. Relationships between the EF scales and tests were low and mostly not significant. Most ADHD adults were clinically impaired on the EF ratings but only a small minority were so on the tests. The EF ratings were more highly associated with measures of deviant behavior (antisocial acts, crime diversity, negative driving outcomes) than the EF tests, most of which were unrelated to such behavior. These results agree with previous research showing that EF tests are largely unrelated to EF ratings and that EF ratings are more strongly associated with impairment in major life activities, in this case deviant or antisocial behavior. Contrary to earlier conclusions based on EF tests, adult ADHD involves substantial problems in EF in daily life.

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Notes

  1. Specific detailed analyses are available upon request from the first author.

References

  • Alderman, N., Burgess, P. W., Knight, C., & Henman, C. (2003). Ecological validity a simplified version of the multiple errands shopping test. Journal of the International Neuropsychological Society, 9, 31–44.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2001). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • Anderson, P. (2002). Assessment and development of executive function (EF) during childhood. Child Neuropsychology, 8, 71–82.

    PubMed  Google Scholar 

  • Anderson, V. A., Anderson, P., Northam, E., Jacobs, R., & Milkiewicz, O. (2002). Relationships between cognitive and behavioral measures of executive function in children with brain disease. Child Neuropsychology, 8, 231–240.

    PubMed  Google Scholar 

  • Badre, D. (2008). Cognitive control, hierarchy, and the rostro-caudal organization of the frontal lobes. Trends in Cognitive Sciences, 12, 193–200.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (1997a). Inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.

    Article  Google Scholar 

  • Barkley, R. A. (1997b/2001). ADHD and the nature of self-control. New York: Guilford.

  • Barkley, R. A. (2006). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York: Guilford.

    Google Scholar 

  • Barkley, R. A. (2011a). The Barkley deficits in executive functioning scale. New York: Guilford.

    Google Scholar 

  • Barkley, R. A. (2011b). Executive functioning in daily life activities: Indictment, integration, extended phenotype, and implications. New York: Guilford.

    Google Scholar 

  • Barkley, R. A., & Biederman, J. (1997). Towards a broader definition of the age-of-onset criterion for attention deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1204–1210.

    Article  PubMed  Google Scholar 

  • Barkley, R. A., & Cox, D. J. (2007). A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance. Journal of Safety Research, 38, 113–128.

    Article  PubMed  Google Scholar 

  • Barkley, R. A., & Fischer, M. (2011). Predicting impairment in occupational functioning in hyperactive children as adults: self-reported executive function (EF) deficits vs. EF tests. Developmental Neuropsychology.

  • Barkley, R. A., & Murphy, K. (2006). Attention deficit hyperactivity disorder: A clinical workbook (2nd and 3rd eds.). New York: Guilford.

  • Barkley, R. A., & Murphy, K. R. (2010). Impairment in occupational functioning in adult ADHD: the predictive utility of executive function (EF) ratings versus EF tests. Archives of Clinical Neuropsychology, 25, 157–173.

    Article  PubMed  Google Scholar 

  • Barkley, R. A., Murphy, K. R., & Bush, T. (2001). Time estimation and reproduction in young adults with attention deficit hyperactivity disorder (ADHD). Neuropsychology, 15, 351–360.

    Article  PubMed  Google Scholar 

  • Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). Persistence of attention deficit hyperactivity disorder into adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology, 111, 279–289.

    Article  PubMed  Google Scholar 

  • Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. New York: Guilford.

    Google Scholar 

  • Biederman, J., Petty, C., Fried, R., Fontanella, J., Doyle, A. E., Seidman, L. J., et al. (2006). Impact of psychometrically defined deficits of executive functioning in adults with attention deficit hyperactivity disorder. The American Journal of Psychiatry, 163, 1730–1738.

    Article  PubMed  Google Scholar 

  • Biederman, J., Petty, C. R., Fried, R., Black, S., Faneuil, A., Doyle, A. E., et al. (2008). Discordance between psychometric testing and questionnaire-based definitions of executive function deficits in individuals with ADHD. Journal of Attention Disorders, 12, 92–102.

    Article  PubMed  Google Scholar 

  • Boonstra, A. M., Oosterlaan, J., Sergeant, J. A., & Buitelaar, J. K. (2005). Executive functioning in adult ADHD: a meta-analytic review. Psychological Medicine, 35, 1097–1108.

    Article  PubMed  Google Scholar 

  • Botvinick, M. M. (2008). Hierarchical models of behavior and prefrontal function. Trends in Cognitive Sciences, 12, 201–208.

    Article  PubMed  Google Scholar 

  • Burgess, P. W., Alderman, N., Evans, J., Emslie, H., & Wilson, B. A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society, 4, 547–558.

    Article  PubMed  Google Scholar 

  • Castellanos, X., Sonuga-Barke, E., Milham, M., & Tannock, R. (2006). Characterizing cognition in ADHD: beyond executive dysfunction. Trends in Cognitive Sciences, 10, 117–123.

    Article  PubMed  Google Scholar 

  • Chaytor, N., Schmitter-Edgecombe, M., & Burr, R. (2006). Improving the ecological validity of executive functioning assessment. Archives of Clinical Neuropsychology, 21, 217–227.

    Article  PubMed  Google Scholar 

  • Conners, C. K. (1995). The Conners continuous performance test. North Tonawanda: Multi-Health Systems.

    Google Scholar 

  • Denckla, M. B. (1996). A theory and model of executive function: a neuropsychological perspective. In G. R. Lyon & N. A. Krasnegor (Eds.), Attention, memory, and executive function (pp. 263–278). Baltimore, MD: Paul H. Brookes.

  • Derogatis, L. (1986). Manual for the Symptom Checklist 90 Revised (SCL-90-R). Baltimore: Author.

    Google Scholar 

  • Egeland, J., & Kovalik-Gran, I. (2010). Measuring several aspects of attention in one test: the factor structure of the Conners’ continuous performance test. Journal of Attention Disorders, 13, 339–357.

    Article  PubMed  Google Scholar 

  • Eslinger, P. J. (1996). Conceptualizing, describing, and measuring components of executive function: A summary. In G. R. Lyon & N. A. Krasnegor (Eds.), Attention, memory, and executive function (pp. 367–395). Baltimore: Paul H. Brookes.

    Google Scholar 

  • Fedele, D. A., Hartung, C. M., Canu, W. H., & Wilkowski, B. M. (2010). Potential symptoms of ADHD for emerging adults. Journal of Psychopathology and Behavioral Assessment, 32, 385–396.

    Article  Google Scholar 

  • Fischer, M., Barkley, R. A., Smallish, L., & Fletcher, K. (2004). Hyperactive children as young adults: deficits in inhibition, attention, and response perseveration and their relationship to severity of childhood and current ADHD and conduct disorder. Developmental Neuropsychology, 27, 107–133.

    Article  Google Scholar 

  • Frazier, T. W., Demareem, H. A., & Youngstrom, E. A. (2004). Meta-analysis of intellectual and neuropsychological test performance in attention-deficit/hyperactivity disorder. Neuropsychology, 18, 543–555.

    Article  PubMed  Google Scholar 

  • Fuster, J. M. (1997). The prefrontal cortex. New York: Raven.

    Google Scholar 

  • Gilotty, L., Kenworthy, L., Sirian, L., Black, D. O., & Wagner, A. E. (2002). Adaptive skills and executive function in autism spectrum disorders. Child Neuropsychology, 8, 241–248.

    PubMed  Google Scholar 

  • Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). BRIEF: Behavior rating inventory of executive function professional manual. Odessa: Psychological Assessment Resources, Inc.

    Google Scholar 

  • Gottfredson, M. R., & Hirschi, T. (1990). A general theory of crime. Stanford: Stanford University Press.

    Google Scholar 

  • Heaton, R. K. (1981). A manual for the Wisconsin card sorting test. Odessa: Psychological Assessment Resources.

    Google Scholar 

  • Hervey, A. S., Epstein, J. N., & Curry, J. F. (2004). Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology, 18, 495–503.

    Article  Google Scholar 

  • Hirschi, T. (2004). Self-control and crime. In R. F. Baumeister & K. D. Vohs (Eds.), Handbook of self-regulation: Research, theory, and applications (pp. 537–552). New York: Guilford.

    Google Scholar 

  • Hollingshead, J. (1975). A four-factor index of social position. Author.

  • Jonsdottir, S., Bouma, A., Sergeant, J. A., & Scherder, E. J. A. (2006). Relationship between neuropsychological measures of executive function and behavioral measures of ADHD symptoms and comorbid behavior. Archives of Clinical Neuropsychology, 21, 383–394.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Adler, L., Barkley, R. A., Biederman, J., Conners, C. K., Demler, O., et al. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. The American Journal of Psychiatry, 163, 716–723.

    Article  PubMed  Google Scholar 

  • Lee, G. P., Strauss, E., Loring, D. W., McCloskey, L., Haworth, J. M., & Lehman, R. A. W. (1997). Sensitivity of figural fluency on the Five-Points Test to focal neurological dysfunction. The Clinical Neuropsychologist, 11, 59–68.

    Article  Google Scholar 

  • Luria, A. R. (1966). Higher cortical functions in man. New York: Basic Books, Inc.

    Google Scholar 

  • Lyon, G. R., & Krasnegor, N. A. (Eds.). (1996). Attention, memory, and executive function. Baltimore: Paul H. Brookes.

    Google Scholar 

  • Mahone, E. M., Hagelthora, K. M., Cutting, L. E., Schuerholz, L. J., Pelletier, S. F., Rawlins, C., et al. (2002). Effects of IQ on executive function measures in children with ADHD. Child Neuropsychology, 8, 52–65.

    PubMed  Google Scholar 

  • Mangeot, S., Armstrong, K., Colvin, A. N., Yeates, K., & Taylor, G. H. (2002). Long-term executive function deficits in children with traumatic brain injuries: assessment using the behavior rating inventory of executive function (BRIEF). Child Neuropsychology, 8, 271–284.

    PubMed  Google Scholar 

  • Marchetta, N. D. J., Hurks, P. P. M., Krabbendam, L., & Jolles, J. (2008). Interference control, working memory, concept shifting, and verbal fluency in adults with attention-deficit/hyperactivity disorder (ADHD). Neuropsychology, 22, 74–84.

    Article  PubMed  Google Scholar 

  • Marcus, B. (2003). An empirical examination of the construct validity of two alternative self-control measures. Educational and Psychological Measurement, 63, 674–706.

    Article  Google Scholar 

  • McGough, J. J., & Barkley, R. A. (2004). Diagnostic controversies in adult ADHD. The American Journal of Psychiatry, 161, 1948–1956.

    Article  PubMed  Google Scholar 

  • Mitchell, M., & Miller, S. (2008). Executive functioning and observed versus self-reported measures of functional ability. The Clinical Neuropsychologist, 22, 471–479.

    Article  PubMed  Google Scholar 

  • Multi-Health Systems, Inc. (1995). The learning and memory battery. North Tonawanda: Multi-Health Systems, Inc.

    Google Scholar 

  • Murphy, K., & Barkley, R. A. (1996). ADHD in Adults: comorbidities and adaptive impairments. Comprehensive Psychiatry, 37, 393–401.

    Article  PubMed  Google Scholar 

  • Murphy, P., & Schachar, R. (2000). Use of self-ratings in the assessment of symptoms of attention deficit hyperactivity disorder in adults. The American Journal of Psychiatry, 157, 1156–1159.

    Article  PubMed  Google Scholar 

  • Murphy, K. R., Barkley, R. A., & Bush, T. (2001). Executive functioning and olfactory identification in young adults with attention deficit hyperactivity disorder. Neuropsychology, 15, 211–220.

    Article  PubMed  Google Scholar 

  • Nigg, J. T., Willcutt, E. G., Doyle, A. E., & Sonuga-Barke, J. S. (2005). Causal heterogeneity in attention-deficit/hyperactivity disorder: do we need neuropsychologically impaired subtypes? Biological Psychiatry, 57, 1224–1230.

    Article  PubMed  Google Scholar 

  • Regard, M., Strauss, E., & Knapp, P. (1982). Children’s production on verbal and non-verbal fluency tasks. Perceptual and Motor Skills, 123, 17–22.

    Google Scholar 

  • Roth, R. M., Isquith, P. K., & Gioia, G. A. (2005). Behavior rating inventory of executive function—adult version. FL: Psychological Assessment Resources, Inc.

    Google Scholar 

  • Ruff, R. M., Allen, C. C., Farrow, C. E., Nieman, H., & Wylie, T. (1994). Figural fluency: differential impairment in patients with left versus right frontal lesions. Archives of Clinical Neuropsychology, 9, 41–55.

    PubMed  Google Scholar 

  • Sergeant, J. A. (2005). Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model. Biological Psychiatry, 57, 1248–1255.

    Article  PubMed  Google Scholar 

  • Shallice, T., & Burgess, P. W. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114, 727–741.

    Article  PubMed  Google Scholar 

  • Shipley, W. C. (1946). The Shipley Institute of living scale. Los Angeles: Western Psychological Services, Inc.

    Google Scholar 

  • Spitzer, R. L., Williams, J., Gibbon, M., & First, M. B. (1995). The structured clinical interview for DSM-IV (SCID). New York: Biometric Research Department, New York State Psychiatric Institute.

    Google Scholar 

  • Stavro, G. M., Ettenhofer, M. L., & Nigg, J. T. (2007). Executive functions and adaptive functioning in young adults with attention-deficit/hyperactivity disorder. Journal of the International Neuropsychological Society, 13, 324–334.

    Article  PubMed  Google Scholar 

  • Stroop, J. P. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643–662.

    Article  Google Scholar 

  • Stuss, D. T., & Benson, D. F. (1986). The frontal lobes. New York: Raven.

    Google Scholar 

  • Trenerry, M., Crosson, B., Deboe, J., & Leber, W. (1989). Stroop neuropsychological screening test. Odessa: Psychological Assessment Resources.

    Google Scholar 

  • Vazsonyi, A. T., & Huang, L. (2010). Where self-control comes from: on the development of self-control and its relationship to deviance over time. Developmental Psychology, 46, 243–257.

    Google Scholar 

  • Vriezen, E. R., & Pigott, S. E. (2002). The relationship between parental report on the BRIEF and performance-based measures of executive function in children with moderate to severe traumatic brain injury. Child Neuropsychology, 8, 296–303.

    PubMed  Google Scholar 

  • Welsh, M. C., & Pennington, B. F. (1988). Assessing frontal lobe functioning in children: views from developmental psychology. Developmental Neuropsychology, 4, 199–230.

    Article  Google Scholar 

  • Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biological Psychiatry, 57, 1336–1346.

    Article  PubMed  Google Scholar 

  • Wood, R. L. I., & Liossi, C. (2006). The ecological validity of executive function tests in a severely brain injured sample. Archives of Clinical Neuropsychology, 21, 429–437.

    Article  PubMed  Google Scholar 

  • Zachary, R. A. (1988). Institute of living scale—revised manual. Los Angeles: Western Psychological Services.

    Google Scholar 

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Acknowledgements

This research was supported by a grant to the first author from the National Institute of Mental Health (MH54509) while he was at the University of Massachusetts Medical School. The preparation of this paper was also supported by a small grant to the first author from Shire Pharmaceuticals. The opinions expressed here, however, do not necessarily represent those of the funding institute or of Shire Pharmaceuticals. We are exceptionally grateful to Tracie Bush for her assistance with the evaluation of the research participants in the study and with their data entry. We also wish to thank Laura Montville for her administrative and data entry assistance.

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  1. Medical University of South Carolina, Charleston, SC, USA

    Russell A. Barkley

  2. Adult ADHD Clinic of Central Massachusetts, Northborough, MA, USA

    Kevin R. Murphy

  3. 1752 Greenspoint Ct., Mt. Pleasant, SC, 29466, USA

    Russell A. Barkley

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Correspondence to Russell A. Barkley.

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Barkley, R.A., Murphy, K.R. The Nature of Executive Function (EF) Deficits in Daily Life Activities in Adults with ADHD and Their Relationship to Performance on EF Tests. J Psychopathol Behav Assess 33, 137–158 (2011). https://doi.org/10.1007/s10862-011-9217-x

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