The symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) have been linked to dysfunction in numerous life domains for both children and adults. As such, it is likely that individuals with these and other related symptoms (e.g., sluggish cognitive tempo, SCT) may also experience impaired quality of life. The current study examines the association between ADHD and SCT symptoms and quality of life (QOL) in a community sample of adults. Quality of life data collected from 983 participants (M age = 45.6 years) were analyzed primarily through a series of hierarchical multiple regressions employing SCT and ADHD symptom clusters, demographic, and anxiety and depression scale variables as predictors. Results generally supported the hypothesis that ADHD and SCT symptoms would negatively associate with QOL. Amongst the indicators, inattention and SCT emerged as the strongest predictors of low QOL. These findings underscore the negative impact of ADHD symptoms in adulthood, the independent contribution of SCT, and the importance of considering QOL in prospective research and intervention.
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Except for social QOL, given that herein this subscale was not included in the total QOL calculation (see Measures, above).
In the hierarchical regression on physical QOL, HI was an additional, modest predictor (β = −.13, p = .024) in Block 3 for the older subsample; for psychological QOL, SCT (β = −.19, p = .002) emerged as a predictor in Block 3 for younger adults, whereas IA (β = −.21, p < .001) did so for older adults.
Note: The shortened version of the psychological QOL subscale employed in this study omitted an item that directly tapped current depression and anxiety.
Able, S. L., Johnston, J. A., Adler, L. A., & Swindle, R. W. (2007). Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychological Medicine, 37, 97–107. doi:10.1017/S0033291706008713.
Agarwal, R., Goldenberg, M., Perry, R., & Ishak, W. W. (2012). The quality of life of adults with attention deficit hyperactivity disorder: a systematic review. Innovation in Clinical Neuroscience, 9, 10–21.
Altfas, J. R. (2002). Prevalence of attention deficit/hyperactivity disorder among adults in obesity treatment. BMC Psychiatry, 2, 1–8. Retrieved from http://www.biomedcentral.com/1471-244X/2/9.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Barkley, R. (2006). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York: Guilford Press.
Barkley, R. A. (2012). Distinguishing sluggish cognitive tempo from attention-deficit/hyperactivity disorder in adults. Journal of Abnormal Psychology, 121, 978–990. doi:10.1037/a0023961.
Barkley, R., & Murphy, K. (2006). Attention- deficit hyperactivity disorder: A clinical workbook (3rd ed.). New York: Guilford.
Barkley, R., Fischer, M., Smallish, L., & Fletcher, K. (2006). Young adult outcomes of hyperactive children: adaptive functioning in major life activities. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 192–202. doi:10.1097/01.chi.0000189134.97436.e2.
Becker, S. P. (2013). Topical review: sluggish cognitive tempo: research findings and relevance for pediatric psychology. Journal of Pediatric Psychology. Advance online publication. doi:10.1093/jpepsy/jsto58.
Biederman, J., Mick, E., & Faraone, S. V. (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. American Journal of Psychiatry, 157, 816–818. doi:10.1176/appi.ajp.157.5.816.
Biederman, J., Petty, C., Evans, M., Small, J., & Faraone, S. (2010). A controlled 10-year follow-up study of boys with ADHD. Psychiatry Research, 177, 299–304. doi:10.1016/j.psychres.2009.12.010.
Bonomi, A. E., Patrick, D. L., Bushnell, D. M., & Martin, M. (2000). Validation of the United States’ version of the World Health Organization Quality of Life (WHOQOL- BREF) instrument. Journal of Clinical Epidemiology, 53, 13–17.
Broman-Fulks, J. J., Canu, W. H., Trout, K. L., & Nieman, D. C. (2012). The effects of quercetin supplementation on cognitive functioning in a community sample: a randomized, placebo-controlled trial. Therapeutic Advances in Psychopharmacology, 2(4), 131–138. doi:10.1177/204512531244589.
Brown, T. (2008). ADHD comorbidities: Handbook for ADHD complications in children and adults. Arlington: American Psychiatric Publishing.
Canu, W. H., & Carlson, C. L. (2007). Rejection sensitivity and social outcomes of young adult men with ADHD. Journal of Attention Disorders, 10, 261–275. doi:10.1177/1087054706288106.
Canu, W. H., Tabor, L. S., Michael, K. D., Bazzini, D. G., Elmore, A. E. (2013). Romantic couples’ conflict resolution and satisfaction varies with partner’s attention-deficit/hyperactivity disorder type. Journal of Marital and Family Therapy. Advance online publication. doi:10.1111/jmft.12018.
Carlson, C. L., & Mann, M. (2002). Sluggish cognitive tempo predicts a different pattern of impairment in the attention-deficit/hyperactivity disorder, predominantly inattentive type. Journal of Clinical Child and Adolescent Psychology, 31, 123–129. doi:10.1207/S15374424JCCP3101_14.
Centers for Disease Control and Prevention (2009). Health related quality of life. Retrieved May 10, 2009 from http://www.cdc.gov/hrqol/.
Combs, M. A., Canu, W. H., Broman-Fulks, J. J. Rocheleau, C. A., Nieman, D. C. (2012). Perceived stress and ADHD symptoms in adults. Journal of Attention Disorders. Advance online publication. doi:10.1177/1087054712459558.
Das, D., Cherbuin, N., Butterworth, P., Anstey, K. J., & Easteal, S. (2012). A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults. PLoS One, 7, e31500. doi:10.1371/journal.pone.0031500.
Davis, C., Levitan, R. D., Smith, M., Tweed, S., & Curtis, C. (2006). Associations among overeating, overweight, and attention-deficit/hyperactivity disorder: a structural equation modeling approach. Eating Behaviors, 7, 266–274. doi:10.1016/j.eatbeh.2005.09.006.
Derogatis, L. R. (1993). Brief symptom inventory (BSI): Administration, scoring, and procedures manual. Minneapolis: Pearson.
Friedrichs, B., Igl, W., Larsson, H., & Larsson, J.-O. (2012). Coexisting psychiatric problems and stressful life events in adults with symptoms of ADHD—a large Swedish population-based study of twins. Journal of Attention Disorders, 16, 13–22. doi:10.1177/1087054710376909.
Garner, A. A., Marceaux, J. C., Mrug, S., Patterson, C., & Hodgens, B. (2010). Dimensions and correlates of attention deficit/hyperactivity disorder and sluggish cognitive tempo. Journal of Abnormal Child Psychology, 38, 1097–1107. doi:10.1007/s10802-010-9436-8.
Hill, R. B., & Petty, G. C. (1995). A new look at selected employability skills: a factor analysis of the occupational work ethic. Journal of Vocational Education Research, 20, 59–73.
Hoza, B., Mrug, S., Gerdes, A. C., Hinshaw, S. P., Bukowski, W. M., Gold, J. A., . . . Arnold, L. E. (2005). What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? Journal of Counseling and Clinical Psychology, 73, 411–423. doi:10.1037/0022-006X.73.3.411.
Huang, I., Wu, A., & Frangakis, C. (2006). Do the SF-36 and WHOQOL-BREF measure the same constructs? Evidence from the Taiwan population. Quality of Life Research, 15, 15–24. doi:10.1007/s11136-005-8486-9.
Kessler, R. C., Adler, L., Barkley, R. O., Biederman, J., Connors, C. K., & Demler, O. (2006). The prevalence and correlates of ADHD in the United States: results from the National Comorbidity Survey Replication (NCS-R). American Journal of Psychiatry, 163, 716–723.
Kofler, M. J., Rapport, M. D., Bolden, J., Sarver, D. E., Raiker, J. S., & Alderson, R. M. (2011). Working memory deficits and social problems in children with ADHD. Journal of Abnormal Child Psychology, 39, 805–817. doi:10.1007/s10802-01109492-8.
Kooij, J. J. S., Buitelaar, J. K., Van Den Oord, E. J., Furer, J. W., Rijnders, C. A. T., & Hodiamont, P. P. G. (2005). Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological Medicine, 35, 817–827. doi:10.1017/S003329170400337X.
Lee, S., Burns, G. L., Snell, J., McBurnett, K. (2013). Validity of the sluggish cognitive tempo symptom dimension in children: sluggish cognitive tempo and ADHD-inattention as distinct symptom dimensions. Journal of Abnormal Child Psychology, Advance online publication. doi:10.1007/s10802-013-9714-3.
Lensing, M. B., Zeiner, P., Sandvik, L., Opjordsmoen, S. (2013). Quality of life in adults aged 50+ with ADHD. Journal of Attention Disorders. Advance online publication. http://jad.sagepub.com/.
Loe, I. M., Balestrino, M. D., Phelps, R. A., Kurs-Lasky, M., Chaves-Gnecco, D., Paradise, J. L., et al. (2008). Early histories of school-aged children with attention-deficit/hyperactivity disorder. Child Development, 79, 1853–1868.
Marshall, S. A., Evans, S. W., Eiraldi, R. B., Becker, S. P., Power, T. J. (2013). Social and academic impairment in youth with ADHD, predominantly inattentive type and sluggish cognitive tempo. Journal of Abnormal Child Psychology. Advance online publication. doi:10.1007/s10802-013-9758-4.
McBurnett, K., Pfiffner, L. J., & Frick, P. J. (2001). Symptom properties as a function of ADHD type: an argument for continued study of sluggish cognitive tempo. Journal Of Abnormal Child Psychology, 29(3), 207–213. doi:10.1023/A:1010377530749.
McConaughy, S. H., Volpe, R. J., Antshel, K. M., Gordon, M., & Eiraldi, R. B. (2011). Academic and social impairments of elementary school children with attention deficit hyperactivity disorder. School Psychology Review, 40, 200–225.
Murphy, K., & Barkley, R. A. (1996). Attention deficit hyperactivity disorder comorbidities and adaptive impairments. Comprehensive Psychiatry, 37, 393–401.
Reaser, A., Prevatt, F., Petscher, Y., & Proctor, B. (2007). The learning and study strategies of college students with ADHD. Psychology in the Schools, 44, 627–638. doi:10.1002/pits.20252.
Riley, A., Spiel, G., Coghill, D., Dopfner, M., Falissard, B., Lorenzo, M., . . . Ralston, S. J. (2006). Factors related to health-related quality of life (HRQoL) among children with ADHD in Europe at entry into treatment. European Child Adolescent Psychiatry, 15, 38–45. doi:10.1007/s00787-006-1006-9.
Sibley, M. H., Pelham, W. E., Molina, B., Gnagy, E. M., Waxmonsky, J. G., Waschbusch, D. A., . . . Kuriyan, A. B. (2012). When diagnosing ADHD in young adults emphasize informant reports, DSM items, and impairment. Journal of Consulting and Clinical Psychology, Advance online publication. doi:10.1037/a0029098.
Sobanski, E., Schredl, M., Kettler, N., & Alm, B. (2008). Sleep in adults with attention deficit hyperactivity disorder (ADHD) before and during treatment with methylphenidate: a controlled polysomnographic study. Sleep, 31, 375–381.
Solanto, M. V., Wasserstein, J., Marks, D. J., & Mitchell, K. J. (2012). Diagnosis of ADHD in adults: what is the appropriate DSM-5 symptom threshold for hyperactivity-impulsivity? Journal of Attention Disorders, 16, 631–634. doi:10.1177/1087054711416910.
Waring, M. E., & Lapane, K. L. (2008). Overweight in children and adolescents in relation to attention-deficit/hyperactivity disorder: results from a national sample. Pediatrics, 122, 1–6. doi:10.1542/peds.2007-1955.
Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. Journal of Adolescent Health, 46, 209–217. doi:10.1016/j.jadohealth.2009.09.009.
Weiss, M., & Murray, C. (2003). Assessment and management of attention-deficit hyperactivity disorder in adults. Canadian Medical Association Journal, 168, 714–722.
Whalen, C., Jamner, L., Henker, B., Gehricke, J., & King, P. (2003). Is there a link between adolescent cigarette smoking and pharmacotherapy for ADHD? Psychology of Addictive Behaviors, 17, 332–335. doi:10.1037/0893-164X.17.4.332.
Young, S., & Gudjonsson, G. (2006). ADHD symptomatology and its relationship with emotional, social, and delinquency problems. Psychology, Crime & Law, 12, 463–471. doi:10.1080/10683160500151183.
This work was supported by grants from the Quercegen Pharma and Coca Cola corporations. The authors would also like to extend their appreciation to the several assistants-- among them Jared Cook, Lindsay Tabor, and Kelsey Toomey-- who helped with the mammoth undertaking of data collection for this study.
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Combs, M.A., Canu, W.H., Broman Fulks, J.J. et al. Impact of Sluggish Cognitive Tempo and Attention-Deficit/Hyperactivity Disorder Symptoms on Adults’ Quality of Life. Applied Research Quality Life 9, 981–995 (2014). https://doi.org/10.1007/s11482-013-9281-3
- Quality of life
- Sluggish cognitive tempo