Barkley2011, Test Vrs Self Reported

This article was downloaded by: [Northeastern University]
On: 19 November 2014, At: 18:11

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered
office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Developmental Neuropsychology
Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/hdvn20
Predicting Impairment in Major Life

Activities and Occupational Functioning
in Hyperactive Children as Adults:
Self-Reported Executive Function (EF)
Deficits Versus EF Tests
a b
Russell A. Barkley & Mariellen Fischer
a
Psychiatry, Medical University of South Carolina , Charleston, South
Carolina, USA
b
Neurobiology, Medical College of Wisconsin , Milwaukee,
Wisconsin, USA
Published online: 23 Feb 2011.
To cite this article: Russell A. Barkley & Mariellen Fischer (2011) Predicting Impairment in Major Life
Activities and Occupational Functioning in Hyperactive Children as Adults: Self-Reported Executive
Function (EF) Deficits Versus EF Tests, Developmental Neuropsychology, 36:2, 137-161
To link to this article: http://dx.doi.org/10.1080/87565641.2010.549877
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis,
our agents, and our licensors make no representations or warranties whatsoever as to
the accuracy, completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content
should not be relied upon and should be independently verified with primary sources
of information. Taylor and Francis shall not be liable for any losses, actions, claims,
proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or
howsoever caused arising directly or indirectly in connection with, in relation to or arising
out of the use of the Content.
This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Conditions of access and use can be found at http://www.tandfonline.com/page/terms-
and-conditions
Downloaded by [Northeastern University] at 18:11 19 November 2014
DEVELOPMENTAL NEUROPSYCHOLOGY, 36(2), 137–161
Copyright © 2011 Taylor & Francis Group, LLC
ISSN: 8756-5641 print / 1532-6942 online
DOI: 10.1080/87565641.2010.549877
Predicting Impairment in Major Life Activities

and Occupational Functioning in Hyperactive Children
as Adults: Self-Reported Executive Function (EF) Deficits
Versus EF Tests
Russell A. Barkley
Psychiatry, Medical University of South Carolina, Charleston, South Carolina
Mariellen Fischer
Neurobiology, Medical College of Wisconsin, Milwaukee, Wisconsin
Hyperactivity in children, or attention deficit hyperactivity disorder (ADHD), is associated with

impairments in various major life activities by adulthood, particularly occupational functioning.
ADHD appears to involve deficits in executive functioning (EF). Prior studies have not examined the
contribution of these deficits to adult impairment generally and occupational adjustment specifically
in longitudinal studies of hyperactive/ADHD children. We did so assessing EF by both self-report
and tests and using self and other-rated impairment in 10 domains of major life activities and 12
measures of occupational impairment. We studied hyperactive (H; N = 135) and community con-
trol children (C; N = 75) followed to adulthood (mean age 27 years). The H cases were subdivided
into those whose ADHD did (ADHD–P) and did not persist (ADHD–NP) using modified DSM-IV
criteria. Self-reported EF deficits were more severe on all five EF scales in the ADHD–P than both
the ADHD–NP and C groups and on three scales in the ADHD–NP compared to C groups. Most
ADHD–P cases fell in the clinically impaired range on self-reported EF as did a substantial minority
of ADHD–NP cases but few were so classified on the EF tests. Impairments in occupational func-
tioning were predicted by the EF ratings to a greater degree than by the EF tests. Most EF tests were
unrelated to work history with the exception of the Five-Points Test. We conclude that EF ratings
are better predictors of impairment in major life activities generally and occupational functioning
specifically at adult follow-up than are EF tests. We hypothesize that this paradox arises from each
method assessing different levels of a hierarchically organized EF meta-construct briefly discussed
herein.
This research was supported by a grant to the first author from the National Institute of Mental Health (MH42181)
while he was at the University of Massachusetts Medical School. The preparation of this article 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.
Correspondence should be addressed to Russell A. Barkley, Ph.D., Department of Psychiatry, Medical University of
South Carolina, 1752 Greenspoint Ct., Mt. Pleasant, SC 29466. E-mail: drbarkley@russellbarkley.org
138 BARKLEY AND FISCHER
Longitudinal studies following hyperactive children (now attention deficit hyperactivity dis-
order [ADHD]) (American Psychiatric Association, 2001) into adulthood reveal impairments
in various major life activities (Barkley, Murphy, & Fischer, 2008), particularly occupational
functioning (Barkley et al., 2008). Children with hyperactivity/ADHD seen at adulthood have:
lower occupational status and annual salaries than control groups followed to adulthood; worse
employer-rated job performance; more job dismissals (being fired) or being laid off; changed
jobs more often; less adequate in fulfilling work demands, less likely to be working indepen-
dently and to complete tasks, and less likely to be getting along well with supervisors as rated by
employers; and poorer performances at job interviews and find certain tasks at work too difficult
for them (Barkley et al., 2008).
Recent theories of ADHD emphasize an important if not central role of EF in the disorder
(Barkley, 1997; Castellanos, Sonuga-Burke, Milham, & Tannock, 2006; Wilcutt, Doyle, Nigg,
Faraone, & Pennington, 2005). Meta-analyses of executive functioning (EF) tests do find a diver-
sity of deficits at the group level of analysis in ADHD cases (Frazier, Demareem, & Youngstrom,
2004; Hervey, Epstein, & Curry, 2004; Wilcutt et al., 2005). Problematic, however, in any effort
to study EF in ADHD is that EF lacks an operational or consensus definition. EF has been defined
by some as those neurocognitive processes necessary for the maintenance of goal-directed prob-
lem solving (Welsh & Pennington, 1988) or the cross-temporal organization of behavior to attain
delayed consequences (Fuster, 1997). But such definitions may be overly broad or are suffi-
ciently ambiguous as to be marginalized in some reviews (Castellanos et al., 2006; Wilcutt et al.
2005) in favor of listing what are thought to be those more specific neurocognitive processes
subsumed under the term. These processes typically include response inhibition, nonverbal and
verbal working memory, emotional and motivational self-regulation, planning and problem solv-
ing or strategy development (goal-directed innovation, fluency, generativity, or reconstitution),
among others (Barkley, 1997; Frazier et al., 2004; Hervey et al., 2004).
Research on EF in ADHD routinely relies on tests of EF as the sole source for documenting
the presence of deficits (Boonstra, Oosterlaan, Sergeant, & Buitelaar, 2005; Hervey et al., 2004).
While group-level studies often do find evidence of EF deficits, studies using individual-level
analyses, such as the proportion of cases that can be classified as clinically impaired, find only
a minority to be so classified (Wilcutt et al., 2005). EF test results also are only weakly related
to severity of ADHD symptoms, if at all (Jonsdottir, Bouma, Sergeant, & Scherder, 2006). From
such evidence some have concluded that ADHD is not necessarily a disorder of EF (Boonstra
et al., 2005; Jonsdottir et al., 2006; Wilcutt et al., 2005). While this is certainly possible, it ignores
the presumption that EF tests are serving as the only indicator of EF deficits.
Numerous reasons exist to question that premise: (1) Most EF tests were not originally devel-
oped to assess EF or its constructs but have been borrowed from other areas of psychological
research (i.e., schizophrenia, brain damage, etc.) (see Lezak, 2004). (2) If EF is conceptual-
ized as the cross-temporal organization of behavior to achieve future goals, then it is far from
clear how EF tests capture this sort of functioning via such short-duration test formats. (3) Most
EF tasks involve multiple cognitive processes, as well as IQ, only some of which supposedly
reflect EF (Anderson, 2002; Mahone et al., 2002) posing some difficulty for their straightfor-
ward interpretation as pure measures of a particular EF construct. (4) EF tests repeatedly show
low ecological validity in adults—that is, they correlate poorly with adult self-ratings and ratings
by significant others of the dysexecutive symptoms observed in patients with frontal lobe injuries
(Burgess, Alderman, Evans, Emslie, & Wilson, 1998; Chaytor, Schmitter-Edgecombe, & Burr,
IMPAIRMENT IN HYPERACTIVE CHILDREN AS ADULTS 139
2006; Wood & Liossi, 2006). (5) Likewise, research using children having various neurological
disorders including frontal lobe injuries and traumatic brain injury (TBI) find low or no signifi-
cant relationships between ratings of everyday EF and EF tests (Anderson, Anderson, Northam,
Jacobs, & Milkiewicz, 2002; Mangeot, Armstrong, Colvin, Yeates, & Taylor, 2002;Vriezen &
Pigott, 2002). The variance shared between any single EF test and EF ratings in these studies
falls below 10% while even the best combination of EF tests shares less than 20% of the vari-
ance with EF ratings. (6) Even such low but significant relationships may become nonsignificant
once IQ is controlled in the analyses (Mangeot et al., 2002). (7) Research also finds low or no
relationships between EF tests and measures of daily functional ability in the elderly, such as self-
care tasks or larger daily responsibilities like managing money, and even the best test composite
explained less than 20% of the variance in functioning (Mitchell & Miller, 2008). Such findings
imply that EF tests are not evaluating the same construct(s) as EF ratings, cannot serve as the
sole source as to how poorly individuals use EF in their daily life activities, and so may not serve
as the sole basis for concluding that disorders, such as ADHD, may not involve deficits in EF.
Evaluating the extent to which EF tests versus EF ratings predict impairment in major domains
of life activities is one means by which to test their relative merits. No prior studies to our knowl-
edge have done so in children with ADHD followed to adulthood. The present study therefore
examined the contributions of EF deficits to global ratings of impairment in 10 domains of major
life activities. It also focused specifically on 12 additional measures of the domain of occupa-
tional functioning. We did so because work encompasses a large part of an individual’s waking
life, places heavy demands on the need for the cross-temporal organization and maintenance of
behavior and problem solving toward goals believed to be the central meaning of EF, and is rated
as among the most impaired domains in adults with ADHD (Barkley et al., 2008). In view of prior
findings noted earlier, we hypothesized that EF ratings would show limited or no relationship to
EF tests and that the EF ratings would prove more strongly related to measures of impairment
than would the EF tests.
Our EF tests were selected to assess the most commonly listed constructs comprising EF, as
noted earlier: response inhibition, nonverbal working memory, verbal working memory, fluency,
and planning and problem solving (Hervey et al., 2004). We used more tests of nonverbal working
memory in view of prior research showing that it may be more deficient in ADHD than verbal
working memory (Martinussen, Hayden, Hogg-Johnson, & Tannock, 2005). Admittedly, this
battery does not provide complete coverage of all constructs that have been attributed to EF, such
as sustained attention or set shifting, but does provide some coverage of most of the constructs
found to be deficient in reviews of EF tests in ADHD. Differences between clinic-referred adults
with ADHD and controls had also been found previously in research using these tests (Barkley
et al., 2008). No EF tests to our knowledge exist that evaluate the construct of emotional and
motivational self-regulation included in some theories of EF and so it also is not represented in
this battery.
METHODS
Participants
This study utilized a group rigorously diagnosed as hyperactive in childhood (N = 158) and a
community control group (N = 81) followed concurrently. These two groups were originally
evaluated in 1979–80 when they were ages 4 to 12 years. At childhood entry into the study, all
participants were required to: (1) have an IQ greater than 80 on the Peabody Picture Vocabulary
Test (Dunn & Dunn, 1981), (2) be free of gross sensory or motor abnormalities, and (3) be the
biological offspring of their current mothers or have been adopted by them shortly after birth.
All parents signed statements of informed consent for their own and their child’s participation in
the study. The gender composition was 91% male and 9% female. The racial composition was
94% white, 5% black, and 1% Hispanic.
The hyperactive group was originally recruited from consecutive referrals to a child psy-
chology service specializing in the treatment of hyperactive children at Milwaukee Children’s
Hospital. To be considered hyperactive, these children had to: (1) have scores on both the
Hyperactivity Index of the Revised Conners Parent Rating Scale (Goyette, Conners, & Ulrich,
1978) and the Werry-Weiss-Peters Activity Rating Scale (see Barkley, 1981) that met or exceeded
two standard deviations above the mean for severity for same age, same sex normal children; (2)
have scores on the Home Situations Questionnaire (HSQ; Barkley, 2006) indicating significant
behavioral problems in at least 6 or more of the 14 problem situations on this scale (a score
exceeding +1 SD); (3) have parent and/or teacher complaints (as reported by parent) of poor
sustained attention, poor impulse control, and excessive activity level; (4) have developed their
behavior problems prior to 6 years of age; (5) have had their behavioral problems for at least 12
months; and (6) have no indication of autism, psychosis, thought disorder, epilepsy, gross brain
damage, or mental retardation. In view of these selection criteria and the close convergence of
rating scale diagnoses with the clinical diagnosis of ADHD (Edelbrock & Costello, 1988), it is
likely that all participants would have met criteria for ADHD based on DSM-III-R had those
been available. Indeed, over 70% of them met the DSM-III-R criteria for ADHD 8–10 years later
at the adolescent follow-up (Barkley, Fischer, Edelbrock, & Smallish, 1990). Although perva-
siveness of symptoms across home and school settings was not required for this study, the vast
majority of children were experiencing problems in both settings. Pervasiveness in the home set-
ting was systematically assessed using the HSQ on which an explicit threshold to enter the study
was specified (see above).
The community control children were recruited using a “snowball” technique in which the
parents of the hyperactive children were asked to provide the names of their friends who had
children within the age range of interest to the study. These friends of the parents then were
contacted about the study. Those volunteering were asked a series of questions over the telephone
to ensure probable eligibility for the project. Those eligible were seen for the initial evaluation. At
that time, they were asked about other friends of theirs who had children and these families then
were contacted to participate and so on. Eligibility was based on: (1) no history of referral to a
mental health professional; (2) no current parental or teacher complaints of significant behavioral
problems; (3) scores within 1.5 standard deviations of the mean for normal children on both
the Hyperactivity Index of the Revised Conners Parent Rating Scale and the Werry-Weiss-Peters
Activity Rating Scale; and (4) no evidence of any other psychiatric disorder. Recruitment into the
initial study did not begin until at least 6 months after the hyperactive group to permit equating
of the groups by age and school grade. As a consequence, at all follow-up points, the hyperactive
group has been slightly older than the control group.Here we report additional results from that
age 27 follow-up in which 135 of the original hyperactive participants agreed to participate (85%)
as did 75 of the original 81 control participants (93%).
The determination of ADHD at this adult follow-up was based upon a structured interview
of DSM-IV criteria conducted by a master’s-level psychologist with specialized training in the
use of this interview and the evaluation of adults with ADHD. The interview was created for use
in prior research projects and showing excellent inter-judge reliability (see Measures below and
also Barkley et al., 2008). Applying the DSM-IV criteria at this adult follow-up is not a straight-
forward matter. One could simply apply the DSM-IV criteria as written to these adults. In doing
so, just 30% of the hyperactive group would meet the threshold of having at least 6 of 9 symp-
toms on either symptom list by self-report (14% Inattentive type, 12% Hyperactive-Impulsive
Type, and 4% Combined type). If we added the additional requirement—having impairment in
at least one or more domains by self-report—the figure falls to 24%. The results for the con-
trol group would be 3% using symptoms only and 1% using symptoms and impairment. There
are numerous reasons to challenge this approach to diagnosing ADHD in adults (see Barkley
et al., 2008). Not the least of those is that the DSM was designed for and tested only on chil-
dren, not adults. Given that ADHD symptoms decline significantly with age in both ADHD
and normal populations, symptom thresholds used with children represent an increasing severity
level with age (Barkley et al., 2008). The threshold of 6 symptoms has been found to be at or
above the 99th percentile for the general population (and of our control group) on each list of
symptoms (Murphy & Barkley, 1996). This would automatically limit the diagnosis in adults to
just the top 1% of the population whereas the 93rd percentile is customarily used as an index
of developmental deviance in studies of children with ADHD (Barkley, 2006). Previous studies
suggest that a threshold of 4 symptoms reflects the +1.5 SD or 93rd percentile on either list for
a general population sample and thus has been previously recommended as an alternative diag-
nostic threshold for adult ADHD (Barkley et al., 2008). If such an adjustment to the threshold
is not done, participants in this study outgrow the DSM criteria as they develop from childhood
to adulthood while remaining highly symptomatic and developmental inappropriate (Barkley et
al., 2008). Therefore, to be considered currently ADHD at follow-up in the hyperactive group,
we required that individuals report at least four or more symptoms on either the inattention or
hyperactive-impulsive symptom list from the DSM-IV and self-report impairment in one or more
domains of major life activity covered in the interview. We found that 55 (44%) of the hyperac-
tive participants met those criteria. Henceforth, we refer to this group as being persistent ADHD
(ADHD–P). The remaining 80 members of the hyperactive group who did not meet these criteria
are referred to as non-persistent ADHD (ADHD–NP). They should not be considered as having
recovered from ADHD since 32% would have been classified as ADHD had others’ reports been
relied upon.
The dimensional demographic measures for these groups are shown in Table 1. They did not
differ in age but, as we have found at the earlier adolescent and adult follow-ups, both hyper-
active groups had less education, lower socio-economic status, and lower IQs than the control
group. These are not confounding variables but are viewed as a consequence of ADHD over
development (Barkley et al., 2008). The three groups did not differ in their sex composition
(84–93% males). As we found at the childhood study entry point and all subsequent follow-
ups, a slightly yet significantly lower percentage of the two hyperactive groups consisted of
self-identified white or European American ethnic identity (81–84% white) in comparison to the
control group (97% white). Seven percent of the hyperactive group identified themselves as black
or African American, 4% as Hispanic or Latino, and 7% as “Other,” mostly Native American.
TABLE 1
Demographic Characteristics by Group for Dimensional Measures for the Milwaukee Study
(1) H+ADHD (2) H−ADHD (3) Community Pair-Wise
Group: Measure Mean SD Mean SD Mean SD F p Contrasts
Age (years) 26.8 1.4 27.2 1.4 27.0 0.9 1.83 NS

Education (years) 12.2 2.2 12.8 2.1 15.8 2.3 51.49 <.001 1, 2 < 3
Verbal IQ (Vocabulary) 10.5 3.4 10.6 3.3 14.1 2.6 29.55 <.001 1, 2 < 3
Nonverbal IQ (Blocks) 11.6 3.2 11.6 3.4 13.0 2.9 4.85 .009 1, 2 < 3
Hollingshead Job Index 32.3 19.8 40.1 20.6 56.0 27.0 18.11 <.001 1, 2 < 3
Hollingshead SES 28.4 11.2 33.2 12.7 45.4 15.1 28.80 <.001 1, 2 < 3
SD = standard deviation, F = F-test results of the analysis of variance (or covariance), p = probability value for
the F-test, NS = not significant. H+ADHD = Hyperactive group that currently has a diagnosis of ADHD at follow-up.
H−ADHD = Hyperactive group that does not have a diagnosis of ADHD at follow-up. Verbal IQ is from the WAIS-III
Vocabulary subtest, Nonverbal IQ is from the Block Design subtest; Hollingshead = Hollingshead Job Index; SES (socio-
economic status) = Hollingshead Index of Social Position. Sample sizes are H+ADHD = 55, H−ADHD = 80, Controls
= 75 for Age, Education, and Hollingshead measure. For WAIS IQ Subtests, they are H+ADHD = 52, H−ADHD, 79,
and Controls = 73.
There was no Asian representation in these samples. The figures for the control group were 0, 0,
and 3%, respectively.
A small percentage of each ADHD group was currently taking a psychiatric medication
(7–14%) and the groups did not differ. We compared those currently receiving medication
(N = 14) to those not doing so on current and childhood ADHD symptom and impairment totals
and found no significant differences. This leads us to believe that medication use is not likely to
have influenced the independent variable in this study, that being level of ADHD at outcome.
Procedures
For this follow-up, all participants were contacted by phone, given an explanation of the study,
and urged to volunteer to be re-evaluated. They were then scheduled for their evaluations over
a two day period at which time formal written consent was obtained. They were then given
a battery of measures that assessed psychiatric disorders, history of mental health treatments,
outcomes in major life activities (education, occupation, dating, sexual activity, driving, money
management, etc.), antisocial activities and drug use, and medical history. Some psychological
tests and rating scales were also collected. Participants were asked to provide the name of another
adult who could best describe their current functioning and to give permission for project staff to
contact and interview this person about them. All interviews were conducted by an experienced
psychological assistant under the supervision of a licensed, board-certified neuropsychologist
after extensive training. This assistant was not blind to original group membership but was blind
to the eventual diagnostic designation of ADHD at follow-up that was used to create the current
ADHD–P and ADHD–NP groups. Participants were paid a stipend for their time and signed
statements of informed consent. The project was reviewed and approved by the medical college
institutional review board for research on human participants.
The breakdown for the relationship of the collateral providing information about the hyper-
active participants was: parent = 39%, sibling = 7%, spouse/partner = 42%, friends = 11%,
and other relative = 1%. For the control group, this breakdown was: parent = 27%, sibling =
4%, spouse/partner = 59%, friend = 11%, and other relative = 0%. The groups did not differ
significantly in these sources of collateral information (X2 = 5.85, p = Not Significant).
Measures Used to Screen and Select Participants
Structured clinical interview for ADHD:. A paper-and-pencil interview was created that
consisted of the criteria from the DSM-IV for ADHD. This interview was employed by an expe-
rienced clinician during the initial interview with participants as part of the selection criteria
used for identifying the groups as ADHD or not. Symptoms of ADHD were reviewed twice,
once for current functioning (past 6 months) and a second time for childhood between 5 and
12 years of age with the requirement that the symptom only be endorsed if it occurs often or
more frequently. The onset of symptoms was also questioned in this interview. Six domains of
impairment were also reviewed with participants requiring them to indicate, as with the ADHD
symptom list, whether or not these domains were impaired often or more frequently. Inter-judge
reliability (agreement) on this structured interview for ADHD DSM-IV criteria was established
as acceptable (85–91%) in a prior study (Barkley et al., 2008).
Adult ADHD Symptoms Scale (Barkley & Murphy, 2006):. Participants completed a rat-
ing scale containing the ADHD items from the DSM-IV. Each item was answered on a 4-point
scale (0–3; Not At All, Sometimes, Often, and Very Often). Validity of the scale has been demon-
strated through past findings of significant group differences between ADHD and control adults
(Barkley et al., 2008). Agreement between self-and other-ratings has been previously found to
range from .64–.75 (Barkley et al., 2008).
Vocabulary and Block Design Subtests from the Wechsler Adult Intelligence Scale
Third Edition (WAIS–III; Wechsler, 1997):. Two subtests were chosen to serve as a proxy
for verbal and nonverbal intelligence (Vocabulary and Block Designs) as they have among the
highest correlations with the Verbal and Nonverbal IQ from the complete test. Scaled scores were
used here.
EF Rating Scale
Deficits in Executive Functioning Interview (DEFI):. A rating scale of executive dysfunc-

tions has been previously developed that consists of 88 items with each item being answered on
a 0–3 Likert scale (0 = rarely or not at all, 1 = sometimes, 2 = often, and 3 = very often). The
scale has two versions for collecting self- and other-reports. Creation of the item pool and the
scale’s construction are explained in the paper by Barkley and Murphy (2011) and the manual for
the scale (Barkley, 2011). The scale evaluates five dimensions of executive dysfunctions: Self-
Management to Time (23 items), Self-Organization & Problem-Solving (21 items), Inhibition
(23 items), Self-Motivation (11 items), and Self-Activation & Concentration (10 items). In this
study, we used an interview to collect information on these same 88 items. Participants were
asked whether or not each item occurred often or more frequently. If so, it was counted as a
symptom of clinical significance. The items were organized into the same five dimensions as on
the rating scale and a total item score was computed for each dimension by summing the number
of items identified as occurring often or more.
Significant differences have been previously reported among clinic-referred adults with
ADHD, clinical control adults, and a community control group on all five scales of both self
and other-rated versions; the ADHD group was rated as having more severe executive dys-
functions than the Clinical control group which was more severe than the Community control
group (Barkley & Murphy, 2011). That same paper reported the relationships between the self-
and the other-ratings to be: Self-Management to Time = .79 (p < .001), Self-Organization =
.66 (p < .001), Inhibition Problems = .74 (p < .001), Self-Motivation = .69 (p < .001), and
Self-Activation/Concentration = .75 (p < .001).
EF Tests
Stroop Color Word Test (Trenerry, Crosson, Deboe, & Leber, 1989). We chose this as
our measure of inhibition. It assesses the ability to inhibit competing responses in the presence
of salient conflicting information. The task is comprised of three parts. In the first part, the par-
ticipant reads a repeating list of color names (e.g., red, blue, green) printed in black ink. In the
second part, the participant names the colors of a repeated series of Xs printed in an ink of those
same colors. In the last or Interference condition, the participant must say the color of ink in
which a color word is printed. For some words, the color of ink in which it is printed is the same
as that of the word while for others, the color of ink differs from that specified by the word. This
portion of the task is believed to reflect problems with the capacity to inhibit habitual or domi-
nant responses (reading the word, in this case). Three scores were derived from this last portion
of the test (Interference): the raw scores for the number of items completed and the number of
incorrect responses, as well as the percentile score. The interference percentile was used here as
our measure of inhibition.
Digit Span from the Wechsler Adult Intelligence Scale 3rd Edition (WAIS–III;
Wechsler, 1997). This test served as our measure of verbal working memory. It involves two
subtests. In one, the examinee is given a series of increasingly longer strings of digits by the
examiner at a rate of one per second. The examiner must repeat them back in the same numerical
sequence. In the second subtest, the examinee must repeat increasingly longer strings of digits
in a backward order from that given by the examiner. For both tests, the participant is given two
trials at each span length. The test ends when the participant fails to repeat both trials correctly at
that span length. The score is the longest span length performed correctly on at least one of the
two trials. The raw scores from both tests were combined to form a single raw score used here.
Kaufman Hand Movements Test from the Kaufman Brief Intelligence Test (Kaufman
& Kaufman, 1993). We employed this test as a measure of nonverbal working memory. The
Hand Movements Test is a well-standardized test for children based on a traditional measure
of frontal lobe function in adults. Children are presented with progressively longer sequences
of three hand movements which they must imitate. We used the scores for number correct and
longest sequence completed.
Simon game. This task was chosen so as to evaluate nonverbal working memory in a
manner equivalent to a digit span forward task. It involves a commercially available game that
consists of a circular plastic device housing four large colored keys on its top surface. When
depressed, each of these keys emits a different tone. When activated, the game automatically
presents a sequence of different tones and lights up the key corresponding to each tone as it does
so. The subject must then press the keys in their correct sequence so as to reproduce the melody.
With each trial, the sequence of tone/key combinations becomes increasingly longer and thus
more complex. The score used here was the longest correctly reproduced sequence. It is akin
to self-ordered pointing tasks (see Lezak, 2004). They were given two trials at each level of the
game (Levels I to IV). The score used here was the number of correct sequences completed.
Five-Points Test of Design Fluency (Lee et al. 1997). This test served as a nonverbal
version of more commonly used verbal fluency tasks. It involves a sheet of paper with 40 five-dot
matrices on it. Participants are required to produce as many different figures as possible by con-
necting the dots within each rectangle within a 3-minute time limit. Not all dots have to be used
and only straight lines between dots are permitted. No figures are to be repeated. If a violation
occurs, participants are given a single warning on the first violation but the rules are not repeated
after any further infractions. Scores are the number of unique designs created, the number of
repeated designs (perseveration), the number of rule infractions, and the percentage of designs
which are repeated designs (percent perseveration). Patients with frontal lobe dysfunction have
a significantly higher percentage of perseverative errors than do neurological patients without
frontal involvement and psychiatric patients (Lee et al., 1997). Ruff, Allen, Farrow, Nieman, and
Wylie (1994) also found the task to be sensitive to frontal lobe injuries and perhaps is more sen-
sitive to right than left lobe involvement. Here we used just the measure of number of unique
designs generated in the task.
Tower of London Test (Shallice & Burgess, 1991). This test served as our measure of
planning and problem solving. It presents the participant with a stand on that contains three
upright spindles of different heights along with three balls of different colors (red, blue, green)
that are arranged on two of these spindles. The participant is then shown a diagram illustrating
the goal or final position in which these balls are to be re-arranged. In proceeding to rearrange
the balls in that final sequence, the participant most do so in the fewest moves. The task requires
that participants look ahead to determine the proper order of moves, and so it is considered a test
of planning ability. The test has been used in a number of neuropsychological studies of children
and adults with ADHD where deficits have been noted (Frazier et al., 2004; Hervey et al., 2004).
Measures of Impairment
Adult ADHD Rating Scale—Impairment Section (Barkley & Murphy, 2006). This
scale, described earlier, contained a separate section in which respondents globally rated the
degree to which any ADHD symptoms produced impairment in 10 domains: home life, work,
social interactions, community activities, educational activities, dating or marriage, money man-
agement, driving, leisure activities, and handling daily responsibilities. Each domain was a single
item and was rated 0–3 as above. We summed them to create an overall impairment index. We
obtained the same rating scale from someone who knew the participant well, typically their
parents, spouses or cohabiting partners, or a sibling.
Structured Clinical Interview of Impairments (Barkley et al., 2008). For this project,
we created an interview consisting of highly specific questions dealing with various domains
of major life activities, including educational history, occupational history, antisocial activities,
drug use, driving, money management, and dating and marital history. This interview was admin-
istered by a psychological technician holding a master’s degree in psychology and trained in the
evaluation of clinic-referred adults. The questions dealing with occupational history are the focus
of this article.
Employer Rated Job Performance at Age 21 Follow-Up. The above impairment mea-
sures were collected at the age 27 follow-up. To avoid relying on just self-reported impairment in
work, we also included here ratings collected from the supervisors of the participants at the age
21 follow-up concerning behavior on the job and overall quality of job performance. Employers
were blind to group status. Employers rated the 14 DSM-III-R items for ADHD and 9 DSM-
III-R items for Oppositional Defiant Disorder (ODD) on a 5-point Likert scale (1–5) (Rarely
to Almost Always). A general rating of current job performance was also obtained using a 5-
point scale (Poor to Excellent). These supervisors were told that the participant had volunteered
to be in a psychology study focusing on job satisfaction and performance. No details about the
psychiatric history of the participant were disclosed.
RESULTS
Group differences on the EF tests, impairment ratings, and occupational measures collected in
this project have been previously published (Barkley et al., 2008). Below we summarize for
readers those group differences we found on those measures. The other results reported below,
however, are original and have not been previously published. Because of the large number of
various statistical tests, we set statistical significance at p < .01 for all Pearson correlations and
analyses of variance and at p < .05 for entry of a variable into any linear regression analyses.
We chose a different p value for the latter analyses because of the exploratory nature of our
investigation into the value of EF measures as predictors of impairment.
We have previously reported (Barkley et al., 2008) that the ADHD–P group was rated as
significantly more impaired in all 10 domains and in the overall impairment score than the
ADHD–NP and Community control group on the self-ratings. Only in money management
and in the overall impairment score was the ADHD–NP group rated as more impaired than
the Community group. On the others’ ratings, the ADHD–P group was more impaired in all
10 domains of as well as the overall impairment score than was the Community group. It was
also rated as more impaired than the ADHD–NP group in their home life, work, social interac-
tions, dating, leisure activities, and management of daily responsibilities. But in several areas,
the two ADHD groups did not differ from each other, these being: community activities, edu-
cation, money management, and driving. And contrary to the results for self-ratings above,
the ADHD–NP group was rated as more impaired in all 10 domains than was the Community
group.
Relationship of EF Tests to DEFI Scales of EF Deficits
We next examined the relationship of the EF tests to the DEFI scales using multiple linear
regression with stepwise entry (SPSS version 17.0). Just one EF test contributed significantly
to the Self-Management to Time scale—the WAIS Digit Span subtest (R = .149, R2 = .022,
F (change) = 4.42, df = 1/194, p = .037). Two EF tests were significantly associated with the
Self-Organization scale, these being WAIS Digit Span (R = .289, R2 = .084, F (change) =17.68,
df = 1/194, p < .001) and KHM Number Correct (R = .321, R2 = .103, R2 change = .020,
F (change) = 4.22, df = 1/193, p = .041). The Inhibition Scale was associated with just one
EF test, that being Simon Longest Correct Sequence (R = .249, R2 = .062, F (change) = 12.83,
df = 1/194, p < .001). Likewise, the Self-Motivation Scale was again associated with this same
EF test (Simon) (R = .234, R2 = .055, F (change) = 11.24, df = 1/194, p = .001). Finally, three
EF tests contributed to the Self-Activation Scale, which were Simon Longest Correct Sequence
(R = .262, R2 = .069, F (change) = 14.32, df = 1/194, p < .001), WAIS Digit Span (R = .303,
R2 = .092, R2 change = .023, F (change) = 4.86, df = 1/193, p = .029), and the TOL Mean
Time to First Move (R = .336, R2 = .113, R2 change = .021, F (change) = 4.57, df = 1/192,
p = .034). In sum, few of these EF tests contributed to EF ratings (DEFI). Those few contributed
just 2 to 8% of the variance in DEFI Scales individually and less than 11% in combination.
Relationship of EF Measures to ADHD Severity
The five DEFI dimensions were significantly inter-correlated, as was previously found for the
rating scale version of this interview (Barkley & Murphy, 2011). The Pearson correlations of
each scale with the others using all participants ranged as follows: Self-Management to Time
correlated .66 to.77 with the other scales; Self-Organization = .63 to .71, Inhibition = .67 to
.75; Self-Motivation = .63 to .77, and Self-Activation = .66 to .75 (all ps < .001). There is
substantial shared variance among the scales, ranging from 40% to 59%. The DEFI scales were
also significantly related to the number of ADHD symptoms (from the interview) when examined
using all participants. The Pearson correlations were: Self-Management to Time = .78 and .57
(inattention and hyperactive-impulsive symptoms, respectively), Self-Organization = .71 and
.52, Inhibition = .66 and .72, Self-Motivation = .73 and .54, and Self-Activation = .69 and .65.
In contrast, the relationships between the EF tests and ADHD symptoms were of a low mag-
nitude and mostly not significant. They were as follows (∗ indicates a p < .01): WAIS Digit Span
= –.18∗ and –.14 (inattention and hyperactive-impulsive, respectively); Simon longest sequence
= –.13 and –.17; Five Points unique designs = –.10 and –.05; Stroop Interference = –.08 and
–.15; Tower of London (TOL) total score = –.10, and –.02; TOL number correct to first trial =
–.12 and –.05; TOL mean time to first move = –.10 and –.10; Kaufman Hand Movements Test
(KHM) number correct = –.19∗ and –.15; and KHM longest correct sequence = –.19∗ and –.14.
At best, EF tests shared less than 4% of their variance with ADHD symptom severity.
Group Differences in Executive Functioning
Next, we examined group differences on the self-reported DEFI Scales. The IQ subtests were
found to be significantly correlated with all five DEFI scales. Those subtests were therefore used
TABLE 2
Comparison of Groups on Self-Reported Deficits in Executive Functioning Interview
(1) ADHD–P (2) ADHD–NP (3) Community Pair-Wise
Group: Measure M SD M SD M SD F p Contrasts
Self-Management 11.7 5.3 4.8 4.1 3.6 3.8 60.92 <.001 1 > 2, 3
to Time
Self-Organization 9.2 5.3 3.8 3.6 1.9 2.8 58.19 <.001 1>2>3
Inhibition 11.7 5.1 5.6 3.9 2.8 3.4 76.03 <.001 1>2>3
Self-Motivation 4.5 2.9 1.7 1.5 1.2 1.8 44.72 <.001 1 > 2, 3
Self-Activation 7.1 2.0 4.2 2.5 2.7 2.4 55.48 <.001 1>2>3
ADHD = Attention deficit hyperactivity disorder group; ADHD–P = Persistent ADHD; ADHD–NP = Non-persistent
ADHD; Community = Community control group. SD = standard deviation. F = results for the omnibus analysis of
variance (or covariance) are indicated on the line labeled with the name of the scale. p = probability value for the
omnibus F-test results; NS = not significant. Where the main effect for Group is significant, pair-wise comparisons are
with the group numbers, such as 1 > 2 > 3 (i.e., ADHD–P > ADHD–NP > Community).
as covariates in the initial omnibus MANCOVA comparing the groups on these DEFI domain
scores. The result for the group comparison was significant nonetheless (Wilks’ Lambda F =
13.24, df = 10/390, p < .001). The results for the univariate tests comparing the three groups
are shown in Table 2. They indicated that the ADHD–P group was rated as having signifi-
cantly greater executive dysfunctions on all five DEFI dimensions than was the case for both the
ADHD–NP and Community groups. The ADHD–NP group also had significantly more severe
scores than the Community group on three of the dimensions, these being Self-Organization and
Problem Solving, Inhibition, and Self-Activation. Covarying IQ out of measures of EF may be
unwise given that EF may contribute to IQ, that IQ is not a confounding factor but is negatively
associated with ADHD to a low but significant degree, and thus removing it reduces variance
in these group comparisons that is related to the independent variable here (ADHD)(Barkley,
1997). By doing so here we have therefore provided a very conservative test concerning the issue
of group differences in EF ratings.
We have previously reported on the differences among these groups on the EF test battery
(Barkley et al., 2008). There we reported that both ADHD groups had lower scores than the
Community group on the Simon test, created fewer unique designs on the Five-Points test, had
lower scores on the WAIS digit span test, and on the Kaufman Hand Movements Test scores.
The two ADHD groups did not differ on these tests, indicating that EF deficits were evident
at age 27 whether or not ADHD persisted to that age. Only the ADHD–P group had a poorer
score on the Stroop Interference score than both the ADHD–NP and Community groups, who
did not differ from each other on this test. All of these differences except that for the Five-Points
test remained significant after controlling for IQ, which, as argued earlier and elsewhere, is a
questionable practice in studies of EF (Barkley, 1997). There were no differences on the Tower
of London test scores.
A more clinically informative approach to examining the EF measures is using an individual
level of analysis in which cases are classified as being impaired or not on the measure and then
computing the percentage of each group that is so impaired. We defined clinical impairment for
TABLE 3
Comparisons of the Groups on the Percentages Falling in the Clinically Significant Range on the
Self-Reports of the Deficits in Executive Functioning Interview and the Executive Function (EF) Tests
Group
Group Scale 1. ADHD–P 2. ADHD–NP 3. Community X2 p< Contrasts
Self-Ratings: % % %
Self-Management to Time 69 19 12 56.91 <.001 1> 2, 3
Self-Organization 67 24 13 46.37 <.001 1> 2, 3
Inhibition 74 29 11 59.22 <.001 1> 2 > 3
Self-Motivation 62 16 11 49.55 <.001 1> 2, 3
Self-Activation/Concentration 76 34 17 47.98 <.001 1> 2 > 3

EF Tests:
WAIS Digit Span 17 19 7 5.13 NS
Simon Longest Sequence 23 23 10 5.82 NS
Five Points – Unique Designs 17 27 8 8.81 .012 2>3
Stroop Interference 14 15 7 2.88 NS
TOL Total Score 20 15 11 1.80 NS
TOL # Correct to First Trial 25 15 10 5.75 NS
TOL Time to First Move 14 21 11 2.87 NS
KHM Number Correct 29 23 4 15.13 .001 1, 2 > 3
KHM Longest Sequence 29 18 8 9.12 .01 1>3
ADHD = Attention deficit hyperactivity disorder group; ADHD–P = Persistent ADHD group; ADHD–NP = Non-
persistent ADHD group; Community = Community control group. SD = standard deviation. % = percent. WAIS =
Wechsler Adult Intelligence Test Digit Span subtest, Simon = Simon Game, Five Points = Five Points Test Number of
Unique Designs score, Stroop = Stroop Word-Color Test, TOL = Tower of London, KHM = Kaufman Hand Movements
subtest.
X2 = results for the omnibus chi-square test; p = probability value for the omnibus X2 test results; NS = not signifi-
cant. Where the X2 test was significant, pair-wise comparisons were conducted and if significant (p < .05) are indicated
in the column labeled “Group Contrasts” where 1 = ADHD–P, 2 = ADHD–NP, and 3 = Community control group.
the DEFI scales as having a score at least 1.5 SDs above the mean of the Community control
group as has been have done previously with other samples (Barkley & Murphy, 2011). This
is roughly equivalent to placing above the 93rd percentile of the community adults. These per-
centages and the chi-square test results used to compare the groups are shown in Table 3. A
substantially greater percentage of the ADHD–P group was impaired on all five DEFI dimen-
sions relative to both the ADHD–NP and the Community control groups. But on two of these
dimensions (Inhibition and Self-Activation), a greater percentage of the ADHD–NP group also
placed in the impaired range than did the Community group.
The percentages of each group classified as impaired on the EF tests are also shown in Table 3.
Again, impairment was defined as +/–1.5 SD of the mean for the Community group. The groups
did not differ from each other on most measures. Across the tests, 14–29% of the ADHD–P group
and 15–29% of the ADHD–NP group fell in the clinically significant range compared to 4–11%
of the Community group. The groups differed on three EF tests. The ADHD–NP group had a
higher percentage in the clinical range than the Community group on the Five-Points Test (27%
vs. 8%). On the Kaufman Hand Movements Test score of number correct, both ADHD groups
(29% and 23%, respectively) had a higher percentage in this range than did the Community
group (4%). On the KHM longest sequence score, just the ADHD–P group differed from the
Community group (29% vs. 8%).
Predicting Impairment in Major Life Activities: DEFI Scales Versus EF Tests
We examined the Pearson correlations between the five DEFI scales and self-rated overall impair-
ment using all participants, which were: Self-Management to Time = .62; Self-Organization =
.63; Inhibition = .67; Self-Motivation = .62; and Self-Activation = .64 (all ps < .001). Thus, 38–
45% of the variance in adaptive impairment is related to executive dysfunctions in daily living
(DEFI scales). For the others ratings of overall impairment, we found: Self-Management to Time
= .41; Self-Organization = .44; Inhibition = .45; Self-Motivation = .37; and Self-Activation =

.35 (all ps < .001). The DEFI scales accounted for 12–25% of the variance in other’s ratings of
impairment.
The relationship of the EF tests to these self- and other-ratings of impairment were sub-
stantially lower and often not significant (p > .01). They were as follows (∗ indicates a p <
.01): WAIS Digit Span = –.17∗ and –.24 (self- and other-ratings, respectively); Simon longest
sequence = –.25∗ and –.25∗ ; Five Points unique designs = –.06 and –.19∗ , Stroop Interference
= –.16 and –.07; Tower of London (TOL) total score = –.09, and –.01; TOL number correct
to first trial = –.14 and –.05; TOL mean time to first move = –.12 and –.04; Kaufman Hand
Movements Test (KHM) number correct = –.20∗ and –.28∗ ; and KHM longest correct sequence
= –.20∗ and –.27∗ .
We then examined which DEFI scales and EF tests made unique contributions to the pre-
diction of overall impairment as indexed by the self- and other-ratings. We used multiple linear
regression to examine the contribution of DEFI Scales to self-rated adaptive impairment. We
then used the same analysis to regress the EF test scores onto self-rated adaptive impairment.
The results appear in Table 4. We found that three DEFI scales made significant contributions to
predicting self-rated adaptive impairment and accounted for 53% of the variance in such impair-
ment. These scales were Inhibition, Self-Organization, and Self-Motivation. In comparison, two
EF tests contributed to the prediction of self-rated impairment but explained only slightly more
than 8% of the variance. The tests were the Simon game longest correct sequence score and the
TOL mean time to first move score.
We conducted these same analyses for predicting the other-ratings of overall impairment and
these results also appear in Table 4. We found that two DEFI scales significantly predicted other-
rated impairment, explaining 23% of the variance in impairment. These were, once again, the
Inhibition and Self-Organization scales. In comparison, we found that two EF tests predicted
other-rated impairment explaining slightly more than 9% of the variance. These were, again, the
Simon game score for the longest correct sequence but also the KHM score for number correct.
In view of the substantial relationship shown above between the DEFI scales and severity of
ADHD symptoms, it is worth considering whether the DEFI scales are merely proxy measures of
ADHD or do they add unique contributions beyond ADHD severity. We repeated the regression
analyses for the DEFI scales in predicting both self- and other-rated adaptive impairment, this
time entering the number of ADHD symptoms reported in the interview at Step 1, and then
allowing the DEFI scales to enter in stepwise fashion at Step 2. This is a very severe test for the
DEFI scales because if one views ADHD as a form of EF disorder, you are removing that shared
EF variance from these analyses. Yet it is still worthwhile evaluating any additional variance that
TABLE 4
Prediction of Overall Adaptive Impairment (Self- and Other-Ratings) From the DEFI Scales and EF Tests
EF Source/Predictors Beta R R2 R2 F p
Overall Adaptive Impairment (self-rated):

DEFI Scales:
Inhibition .340 .673 .453 .453 165.06 <.001
Self-Organization and Problem-Solving .283 .717 .514 .060 24.56 <.001
Self-Motivation .195 .728 .530 .016 6.84 .01
EF Tests:
Simon Longest Correct Sequence −.263 .248 .062 .062 12.21 .001
TOL Mean Time to First Move −.148 .288 .083 .022 4.36 .038
Overall Adaptive Impairment (other-rated):

DEFI Scales:
Inhibition .284 .449 .201 .201 49.93 <.001
Self-Organization and Problem-Solving .247 .485 .235 .034 8.72 .004
EF Tests:
Simon Longest Correct Sequence −.192 .265 .070 .070 13.99 <.001
KHM Number Correct −.166 .304 .092 .022 4.52 .035
Analyses are for linear multiple regression with stepwise entry. Beta = Standardized Beta Coefficient from the final
model, R = Regression coefficient, R2 = Percent of explained variance accounted for by all variables at this step, R2
(Change) = Percent of explained variance accounted for by this variable added at this step, F = F to Change results,
p = probability value for the F-test. DEFI = Deficits in Executive Functioning Interview; EF = executive function;
Simon = Simon Game; TOL = Tower of London; KHM = Kaufman Hand Movements Test.
EF deficits in daily living may explain beyond that accounted for by ADHD symptoms even if
the latter do represent EF deficits. For self-rated impairment, the Inhibition and Self-Organization
scales were still significantly predictive of such impairment and added 8% more variance to the
prediction beyond ADHD severity.1 The same two DEFI scales also predicted the other-ratings of
adaptive impairment after controlling for ADHD severity, accounting for 6% additional variance
beyond ADHD severity. We took the same approach to evaluating the utility of the EF tests
in predicting both self- and other-rated impairment. In the prediction of self-ratings, the Simon
score continued to be significant but explained just 1.4% of additional variance beyond that
explained by ADHD severity. The TOL score no longer made a significant contribution to self-
rated impairment. The same held true for the prediction of other-rated adaptive impairment. The
Simon score remained a significant predictor beyond ADHD severity, adding 3.6% additional
explained variance while the KHM score was no longer a significant predictor.
Relationship of DEFI Scales to Occupational Impairments
We have previously reported the group differences on the occupational measures (Barkley et al.,
2008). To summarize, both ADHD groups had lower Hollingshead Job Index scores and worked
fewer hours per week than the control group at follow-up. The ADHD–P group had held more
jobs since leaving high school, had lower self-rated work quality scores, and had a higher
1 Specific detailed analyses are available on request from the first author.
TABLE 5
Correlations of Deficits in Executive Functioning Interview (DEFI) With Occupational Measures
DEFI Scales
Occupational Measure SMT SOPS INH SMO SAC
Hollingshead Job Index −.35∗ −.29∗ −.35∗ −.29∗ −.33∗

Current salary −.27∗ −.27∗ −.21∗ −.22∗ −.18
Self-rated quality of work .30∗ .34∗ .29∗ .34∗ .33∗
Average duration of employment −.08 −.09 −.14 −.08 −.11
%Jobs - Trouble Getting Along with Others .33∗ .43∗ .45∗ .33∗ .39∗
%Jobs - Trouble with Own Behavior/Work .41∗ .45∗ .44∗ .42∗ .45∗
%Jobs From Which Were Fired .34∗ .24∗ .32∗ .33∗ .28∗
%Jobs Quit Due to Hostility with Employer .21∗ .15 .30∗ .24∗ .25∗
%Jobs Quit Due to Boredom .14 .14 .17 .23∗ .13
%Jobs in Which Formally Reprimanded .39∗ .37∗ .44∗ .34∗ .36∗
DEFI Scale Abbreviations: SMT = Self- Management to Time, SOPS = Self-Organization & Problem-
Solving, INH = Inhibition, SMO = Self-Motivation, and SAC = Self-Activation & Concentration. Analyses
are Pearson product moment correlations. ∗ = indicates that the correlation was significant with a p < .01.
Self-rated work performance and employer-rated work performance were rated as 1 (excellent) to 5 (very
poor).
percentage of jobs in which they had trouble with others, had behavioral problems, had been
fired, or had been formally disciplined by their employers than the other two groups. The ADHD–
P group also had a higher percentage of jobs in which they experienced hostility with their
supervisor than the C group.
The Pearson correlations between the DEFI scales and these various measures of occupational
impairment are shown in Table 5. Here it can be seen that the five DEFI scales were significantly
related to all but two of the work impairment measures, these being the average duration of
employment per job held since leaving high school and the percentage of jobs the applicant had
quit due to boredom.
Relationship of EF Tests to Occupational Impairments
The EF tests, in contrast, were largely unrelated to most of the measures of occupational adjust-
ment. The WAIS–III Digit Span test was significantly related to the Hollingshead Job Index
(r = .31), current salary (.26), and self-rated work quality (–.22)(all ps < .01) but not to any other
occupational measures. The Simon longest correct sequence was significantly related to just the
Hollingshead Index (.21). The Five-Points Test unique designs score was significantly associated
with the Hollingshead index (.36), current salary (.29), and self-rated work quality (–.25) but
to no other measures of impairment. The Stroop Interference score was significantly related to
just the Hollingshead Index (.19) and no other measures. The three scores from the Tower of
London Tests were not significantly related to any occupational measures. The Kaufman Hand
Movements Test score of number correct was associated with four job measures, these being
Hollingshead index (.33), self-rated work quality (–.23), and the percentage of jobs on which
they had problems with others (–.21) and on which they had problems with their own behav-
ior (–.18). The longest correct sequence score from that test was also related to these same job
measures (.31, –.24, –.19, and –.18, respectively). In summary, most of the EF tests were related
to the current job index rating and the participant’s self-rated quality of work but not to the
various measures of job-related problems.
Predicting Impairment in Occupational Functioning: DEFI Scales Versus EF Tests
To determine which of the DEFI scales made unique contributions to predicting the occupa-
tional outcomes we used multiple linear regression based on the entire sample of participants.
We entered the five DEFI scores using stepwise entry. The results are shown in Table 6. Most
outcomes were predicted by one or two of the DEFI scales. The Inhibition problems scale
TABLE 6
Prediction of Occupational Impairments From the DEFI Scales
Impairment/Predictors Beta R R2 R2 F p
Hollingshead Job Index:

Inhibition −.214 .353 .125 .125 28.88 <.001
Self-Management to Time −.196 .379 .144 .019 4.49 .035
Current Salary:
Self-Organization & Problem-Solving .273 .074 .074 14.86 <.001
Work Quality (self-rated):
Self-Organization & Problem-Solving .208 .342 .117 .117 24.20 <.001
Self-Motivation .198 .372 .138 .021 4.52 .035
% Jobs—Trouble Getting Along with Others:
Inhibition .282 .446 .199 .199 48.51 <.001
Self-Organization & Problem-Solving .250 .485 .235 .036 9.03 .003
% Jobs—Trouble with Own Behavior:
Self-Organization & Problem-Solving .275 .449 .202 .202 48.97 <.001
Inhibition .265 .491 .241 .040 10.14 .002
% Jobs—From Which You Were Fired:
Self-Management to Time .339 .339 .115 .115 26.60 <.001
% Jobs—Quit Due to Hostility with Boss:
Inhibition .302 .302 .091 .091 20.44 <.001
% Jobs—Quit Due to Boredom:
Self-Motivation .227 .227 .052 .052 11.17 .001
% Jobs—On Which You Were Reprimanded:
Inhibition .436 .436 .190 .190 48.11 <.001
Employer Rated Work Performance (age 21):
Employer Rated ADHD Severity (age 21):
Employer Rated ODD Severity (age 21):
Inhibition .324 .324 .105 .105 18.03 <.001
Analyses are for linear multiple regression with stepwise entry. Beta = Standardized Beta Coefficient from the
final model, R = Regression coefficient, R2 = Percent of explained variance accounted for by all variables at this
step, R2 (Change) = Percent of explained variance accounted for by this variable added at this step, F = F to
Change results, p = probability value for the F-test. DEFI = Deficits in Executive Functioning Interview. ADHD =
Attention deficit hyperactivity disorder. ODD = Oppositional Defiant Disorder.
TABLE 7
Prediction of Occupational Impairments from the EF Tests
Impairment/Predictors Beta R R2 R2 F p
Hollingshead Job Index:

Five-Points Test—# unique designs .277 .372 .139 .139 30.92 <.001
KHM # correct .170 .398 .159 .020 4.52 .035
Current Salary:
Five Points Test— # unique designs .291 .291 .084 .084 16.24 <.001
Work Quality (self-rated):
KHM Longest correct sequence .273 .273 .074 .074 14.00 <.001
% Jobs—Trouble Getting Along with Others:
KHM # correct .209 .209 .044 .044 8.39 .004

% Jobs—Trouble with Own Behavior:
KHM Longest correct sequence .198 .198 .039 .039 7.44 .007
% Jobs—From Which You Were Fired:
Simon game—Longest correct sequence .155 .155 .024 .024 4.79 .030
% Jobs—Quit Due to Hostility with Boss:
No EF tests predicted this outcome
%Jobs—Quit Due to Boredom:
No EF tests predicted this outcome
% Jobs—On Which You Were Reprimanded:
Employer Rated Work Performance (age 21):
KHM # correct .275 .275 .075 .075 11.82 .001
Employer Rated ADHD Severity (age 21):
Employer Rated ODD Severity (age 21):
KHM Longest correct sequence .421 .421 .177 .177 31.28 <.001
Analyses are for linear multiple regression with stepwise entry. Beta = Standardized Beta Coefficient from the
final model, R = Regression coefficient, R2 = Percent of explained variance accounted for by all variables at this
step, R2 (Change) = Percent of explained variance accounted for by this variable added at this step, F = F to
Change results, p = probability value for the F-test. DEFI = Executive Dysfunction Interview; EF = executive
function; Simon = Simon Game; TOL = Tower of London; KHM = Kaufman Hand Movements Test. ADHD =
Attention deficit hyperactivity disorder. ODD = Oppositional Defiant Disorder.
contributed to 6 of the 12 occupational outcomes, while the Self-Management to Time scale pre-
dicted 4 of the outcomes (Hollingshead Index, % jobs from which you were fired, and Employer
rated ADHD and work quality at age 21). The Self-Organization scale also contributed to the
prediction of 4 outcomes (salary, self-rated work quality, percentage of jobs had trouble with
others, and percentage of jobs had trouble with own behavior). The Self-Motivation scale con-
tributed to two outcomes, these being self-rated work quality and the percentage of jobs quit due
to boredom. The DEFI scales contributed from 5% to 24% of the variance in these occupational
outcomes.
We then conducted the same analyses using the EF tests to predict these occupational out-
comes. Those results appear in Table 7. Only three EF tests were significant, these being the Five
Points Test (unique designs score), the Kaufman Hand Movements Test, and the Simon game, all
of which are considered here to reflect nonverbal working memory and fluency. These EF tests
accounted for 2–17% of the variance in the outcomes.
Finally, we wished to know if the variance in the occupational outcomes being predicted by
the DEFI scales and EF tests was redundant in nature or whether each source of EF informa-
tion was making unique contribution to predicting these outcomes. We therefore repeated the
regression analyses entering both the EF self-report scores and EF tests using stepwise regres-
sion. For only three of the outcomes did an EF test make an independent contribution beyond
that made by the EF scales.2 The Hollingshead Index was predicted by both the Five-Points Test
(13.4% of variance) and the DEFI Self-management to Time scale (10% additional variance).
The measure of current salary was likewise predicted by both of these EF sources (8.4% and
6.6%, respectively). Self-rated work quality was predicted by both the Self-Organization scale
from the DEFI (12.7%) and the Five-Points Test (4.1%). None of the other occupational mea-
sures were predicted by the EF tests. Only the DEFI scales predicted these outcomes as already
shown in Table 6. Thus, one EF Test of nonverbal working memory and fluency (Five Points
Test) appears to make a unique contribution to predicting some of these occupational outcomes
beyond that predicted by the EF self-report scales.
DISCUSSION
This study focuses on the relative merits of two methods of assessing EF: tests versus ratings. We
initially found that the EF ratings (DEFI scales) were significantly inter-related, sharing 40–59%
of their variance. We take this to indicate that a more global meta-construct of EF may underlie
these specific EF dimensions, much as internalizing and externalizing meta-constructs or broad
bands appear to underlie more specific dimensions of child and adult psychiatric symptoms or
the construct of g underlies more specific forms of human intelligence. As in those areas of
psychological research, retaining the specific dimensions of functioning does add some unique
variance (at least 41%) beyond that communally shared among the dimensions. Thus, we would
argue for continuing to study the value of these five specific dimensions of EF deficits in daily
living in future research on EF despite their substantial shared variance.
We also found support for our hypothesis that EF tests would be largely unrelated to these EF
ratings in daily living as reflected in the DEFI scales. This was previously shown to be the case
as well for its rating scale equivalent with adults clinically referred and diagnosed as ADHD
(Barkley & Murphy, 2011). Even where relationships were found here, the EF tests explained
just 2–8% of the variance in DEFI Scales individually and less than 11% when considering
their best combination. These results contribute more evidence for the low ecological validity
of EF tests. As discussed earlier, past studies likewise found that EF tests correlate poorly with
patient self-ratings and those of significant others in adult cases of frontal lobe injuries (Burgess
et al., 1998; Chaytor et al. 2006; Wood & Liossi, 2006) and children with various neurological
injuries (Anderson et al., 2002; Mangeot et al., 2002; Vriezen & Pigott, 2002). Like our study,
that research found the variance shared between any single EF test and EF ratings fell below
10%. The best combination of EF tests shared less than 20% of the variance with EF ratings.
One approach to evaluating the relative merits of these two approaches to assessing EF is
to examine their respective ability to predict impairment in important domains of major life
2 See footnote 1.
activities. We attempted to do so using both self-ratings and other-ratings of adaptive impair-

ment capturing 10 different major life activities. We hypothesized that the EF ratings would
prove superior to the tests in this regard. The evidence confirmed this hypothesis in that the
individual DEFI scales accounted for 38–45% of the variance in self-rated impairment and their
best combination explained 53% of the variance. We also found that the individual DEFI scales
accounted for up to 20% of the variance in other-rated impairment with their best combination
explaining 23%. These figures are substantially higher than the 1 to 8% of variance in impair-
ment accounted for by the EF tests. These results are consistent with earlier research (Mangeot
et al., 2002; Mitchell & Miller, 2008) showing equally disappointing relationships between EF
tests and measures of daily adaptive functional ability.
A second major aim of this study was to determine the extent to which occupational status
and impairment was a function of the deficits in EF associated with ADHD. To our knowledge,
this is the first study to examine the contribution of EF deficits to the occupational adjustment
of hyperactive children followed to adulthood. We also wished to evaluate the relative utility of
self-reports of EF deficits in daily living compared to EF tests in predicting or contributing to
these occupational difficulties. EF ratings were significantly correlated with 10 of the 12 occupa-
tional outcomes measured in this study. When examined jointly, several DEFI scales made unique
contributions to various occupational outcomes. The Inhibition problems scale in particular con-
tributed to 6 of the 12 occupational measures, contributing from 9–24% of the variance in each of
those outcomes. The DEFI scale evaluating Self-Management to Time contributed to four of the
occupational outcomes, while the Self-Organization and Problem-Solving scale contributed to
four other outcomes. In other words, these three DEFI scales made some unique contribution to
all of the occupational impairment measures used here. The Self-Motivation scale contributed to
two outcomes but added just 2–5% of explained variance, and so it is clearly less of a contributor
to work adjustment than are the other three scales. The Self-Activation and Concentration scale
was not predictive of any occupational measures.
In contrast, most of the EF tests did not predict the occupational outcomes. Several did so to a
small but significant degree, however. Interestingly, all were used here as indicators of nonverbal
working memory (or fluency). These tests were the Five Points Test (unique designs score), the
Kaufman Hand Movements Test, and the Simon game. They accounted for 2–17% of the variance
in the outcomes though on most measures their predictive contribution was 8% or less. They were
chiefly predictive of current job status index, current salary, and self-rated work quality. Yet the
EF self-reports on the DEFI accounted for 2–4 times more variance in the occupational outcomes
than did the EF tests. When both the EF self-reports on the DEFI and the EF test scores were used
jointly to predict occupational outcomes, just the score from the Five-Points Test added unique
variance to explaining several outcomes (job index, salary, self-rated work quality) besides that
accounted for by one or more of the DEFI scales. For the remaining nine occupational measures,
including employer ratings of work performance, ADHD, and ODD symptoms collected at the
previous age 21 follow-up, only the DEFI scales made significant contributions to these outcomes
while no EF tests did so. By this approach to predicting occupational impairment, self-reports of
EF deficits in daily living are more useful than EF tests.
These results are highly similar to those recently obtained in a study of clinic-referred adults
diagnosed with ADHD along with both clinical and community control groups (Barkley &
Murphy, 2010). That study also found that self- and other-ratings of EF were superior to an
EF test battery in predicting various occupational impairments. There the Five-Points Test was
again among the best of the EF tests, along with commission errors and reaction time variability
on a continuous performance test (CPT)—an EF test we did not use at this follow-up. We can
only speculate as to why measures of nonverbal working memory/fluency would prove to be so
useful. Perhaps it reflects the fact that ADHD and its associated EF deficits may be more related
to right than left hemisphere maldevelopment. Neuro-imaging studies of ADHD indicated that
where asymmetries in brain size or functioning are evident, they consistently show greater prob-
lems in the right hemisphere and right frontal lobe specifically (Valera, Faraone, Murray, &
Seidman, 2007). Past studies show that the right frontal lobe most likely mediates performance
on the Five-Points Test (Ruff et al., 1994). Reviews of research on working memory in ADHD
likewise find that measures of nonverbal working memory are significantly more impaired than
those of verbal working memory (Martinussen et al., 2005). Our research adds to this literature
by showing that such tests are also more predictive of impairment generally and in occupational
functioning specifically in samples that vary in severity of ADHD in adulthood.

Viewed in their entirety, such findings indicate that EF tests cannot be used as the sole source
or standard to evaluate how poorly individuals use EF in their daily life activities, whatever
other purposes such tests may serve. And contrary to previous investigations, nor can such test
results be used to conclude that particular disorders, such as ADHD, may or may not involve
deficits in EF as many investigators have done (Boonstra et al., 2005; Frazier et al., 2004; Hervey
et al., 2004; Jonsdottir et al., 2006; Marchetta et al., 2008). Past findings indicate that ADHD
is highly associated with deficits in EF in daily life activities in clinic-referred adults diagnosed
with the disorder (see also Barkley & Murphy, 2011). The vast majority of those adults (89–
98%)(Barkley & Murphy, 2011), like the vast majority of hyperactive children whose ADHD
persisted to adulthood in this study, were clinically impaired (placed above the 93rd percentile)
in all five dimensions of executive dysfunctions. In contrast, an earlier study of EF tests (Barkley
& Murphy, 2010) found that only a minority of those same clinic-referred adults with the disorder
had deficits evident to this same degree on an EF test battery. The results reported here replicate
those earlier findings in that only a minority of the ADHD groups fell in the clinically impaired
range on our EF tests. Perhaps this disparity between tests and ratings arises from the fact that
EF tests simply cannot adequately capture the cross-temporal organization and future-directed
nature of EF in daily life as well as reports provided either by patients or those who know them
well that ascertain EF over weeks and months of daily life.
We believe that this disparity in findings is more likely a consequence of the fact that, like
the functional organization of the frontal lobe (Badre, 2008), EF is hierarchically organized and
may best be conceptualized as a meta-construct involving five or more levels. The domain of
EF, like that of driving motor vehicles, probably involves several levels of increasing complexity
of functioning. At each new level, larger and longer-term goals arise that serve to organize and
drive the increasingly complex nested sets of behavioral sequences needed to achieve them via
management of the lower levels. Larger social networks also become increasingly necessary to
achieving those goals via mutualism (social symbiosis). At each new level, new abilities and
skills are needed to function that are not represented at lower levels and yet are essential to
effective self-regulation across time to achieve goals of greater temporal duration.
Specifically, Barkley (2011) has hypothesized an initial pre-executive level comprising several
neurocognitive capacities that will be used to create the initial EF level but are not themselves
EF, such as sensory-motor, visuospatial and language capacities. The instrumental–cognitive EF
system is built on this initial level and likely represents the most proximal form of EF processing
closest to moment-to-moment brain functioning that is most likely reflected in EF tests. Here
pre-executive processes become self-directed and internalized for self-control (Barkley, 1997).
On top of this level will arise the methodical—self-reliant level that represents the use of the
instrumental EFs in solving problems related to meeting daily needs of survival and welfare.
Above this level arises the tactical–interactive level of EF abilities that are used in daily social
interactions and relatively short-term goal accomplishment related to social reciprocity, trade,
and social skills (hours to days). Yet these goals serve as means to accomplishing larger goals
over much longer time periods and larger domains of cooperative social interactions involv-
ing larger numbers of people, longer-term goals, and more complex cross-temporal behavioral
structures, such as educational, work, cohabiting, child-rearing, financial management, driving,
and community domains that can be considered the strategic–cooperative level of EF (weeks
to months). EF ratings are likely capturing the adaptive through strategic levels. This explains
their low order relationships to the instrumental EFs. These higher levels of EF serve to accom-
plish far longer-term goals that may span months to years such as attaining educational degrees,
long-range occupational goals such as promotions, financial planning for major purchases or
even retirement, sustaining long-term friendships or cohabiting relationships, raising offspring
to maturity, behaving ethically and engaging politically in community affairs, and so on. This
level is not an EF but reflects the success of using EF for such longer-term goals, and may be
considered as the ultimate utility of the various EF levels. Measures of impairment such as those
used here likely capture the consequences of the strategic and ultimate utility levels of EF. Thus
EF tests should not be viewed as being pitted against EF ratings at the same level of analysis but
as different measures of different levels of the EF meta-construct that serve different purposes as
a function of the goals of EF assessment.
Our study is not without some noteworthy limitations. One involves the method we used
to create the EF scale, despite its sizeable initial item pool, may not have represented other
dimensions of EF deficits. Yet we believe our initial efforts were sufficiently comprehensive to
provide a first broad pass at determining the possible nature of EF deficits in daily life. It was
certainly more comprehensive, theory-based, and empirically constructed than the brief 20 item
EF scale created in the study by Burgess et al. (1998). Another limitation is the limited EF test
battery employed here. Other EF tests might have performed better. We are doubtful of this
possibility given that past studies concerning the relationships of EF ratings to EF tests have
used a wide variety of putative EF tests with equally disappointing results in either identifying
cases as clinically impaired or in their ecological validity. A third limitation may rest in our
relatively crude measure of adaptive impairment, representing merely ratings on a 4-point Likert
scale assessing the 10 areas of major life activities by self- and other-ratings. Collapsing across
these specific domains to create an overall adaptive impairment index provided a wider ranging,
more global index of impairment. Yet this approach may have inflated the relationship of the
EF ratings to the ratings of impairment as a function of shared method and source. Even so, we
found significant relationships between self-rated EF deficits and other-rated impairments, thus
removing shared source as one explanation for these sizeable relationships between DEFI scales
and impairments. It is still important, however, for future research to evaluate the relationship of
EF ratings to more objective and specific measures of major life impairments apart from self-
ratings, such as measures of driving, education, and so on that are independent of self-reports. A
related limitation is that a number of our occupational impairment measures were derived from
self-reports of work history. These may be affected by recall biases and other influences that
may make them less than accurate in reflecting the actual employment problems experienced
by these participants. We tried to overcome this by also evaluating the reports of employers
about workplace performance, ADHD, and ODD symptoms from our earlier follow-up of these
samples (age 21). But this does not completely eliminate the problems with the historical nature
of the self-reported information. Other sources of occupational information apart from self-report
should be collected in future research in an effort to replicate and extend our findings.
Our results show that self-reports of EF deficits are not sampling the same constructs as are EF
tests and that EF tests have low ecological validity. ADHD is associated with more impairment
in EF in daily life activities than is evident on EF tests. These results for EF ratings also support
the increasingly widespread view that ADHD is an executive function disorder and that those
EF deficits contribute to impairment in major life activities even if this is far less evident from
putative EF tests. We propose that this disparity between EF tests and EF ratings is likely due to
their assessing different levels of a hierarchically organized EF system that can be conceptualized
as a meta-construct. Each level gives rise to longer-term goals that require new abilities and skills
so as to create increasingly more complex nested sets of goal directed activities organized and
sustained across increasingly longer temporal durations and involving larger social networks to
attain.
ACKNOWLEDGMENTS
We are exceptionally grateful to Lorri Bauer, Keith Douville, and Cherie Horan for their assis-
tance with the evaluation of the research participants and to Peter Leo for assistance with data
entry.
REFERENCES
American Psychiatric Association (2001). Diagnostic and statistical manual of mental disorders (4th ed.). Washington,
DC: Author.
Anderson, P. (2002). Assessment and development of executive function (EF) during childhood. Child Neuropsychology,
8, 71–82.
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.
Badre, D. (2008). Cognitive control, hierarchy, and the rostro-caudal organization of the frontal lobes. Trends in Cognitive
Sciences, 12, 193–200.
Barkley, R. A. (1981). Hyperactive children: A handbook for diagnosis and treatment. New York: Guilford.
Barkley, R. A. (1997). ADHD and the nature of self-control. New York: Guilford Press.
Barkley, R. A. (2006). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.).
New York, NY: Guilford Press.
Barkley, R. A. (2011). Executive functioning in daily life: Integration, extended phenotype, and clinical implications.
New York, NY: Guilford Press, in press.
Barkley, R. A., Fischer, M., Edelbrock, C. S., & Smallish, L. (1990). The adolescent outcome of hyperactive children
diagnosed by research criteria, I: An 8-year prospective follow-up study. Journal of the American Academy of Child
and Adolescent Psychiatry, 29, 546–557.
Barkley, R. A., & Murphy, K. R. (2006). Attention deficit hyperactivity disorder: A clinical workbook (3rd ed.). New
York: Guilford.
Barkley, R. A., & Murphy, K. R. (2010). Impairment in major life activities and adult ADHD: The predictive utility of
executive function (EF) ratings vs. EF tests. Archives of Clinical Neuropsychology, 25, 157–173.
Barkley, R. A., & Murphy, K. R. (2011). The nature of executive function (EF) deficits in daily life activities in adults with
ADHD and their relationship to performance on EF Tests. Journal of Psychopathology and Behavioral Assessment,
in press.
Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. New York: Guilford.
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.
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.
Castellanos, X., Sonuga-Barke, E., Milham, M., & Tannock, R. (2006). Characterizing cognition in ADHD: Beyond
executive dysfunction. Trends in Cognitive Science, 10, 117–123.
Chaytor, N., Schmitter-Edgecombe, M., & Burr, R. (2006). Improving the ecological validity of executive functioning
assessment. Archives of Clinical Neuropsychology, 21, 217–227.
Dunn, L. M., & Dunn, L. M. (1981). Peabody Picture Vocabulary Test–Revised. Circle Pines, MN: American Guidance
Service.
Edelbrock, C. S., & Costello, A. (1988). Convergence between statistically derived behavior problem syndromes and
child psychiatric diagnoses. Journal of Abnormal Child Psychology, 16, 219–231.
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.
Fuster, J. M. (1997). The prefrontal cortex. New York: Raven.
Goyette, C. H., Conners, C. K., & Ulrich, R. F. (1978). Normative data for Revised Conners Parent and Teacher Rating
Scales. Journal of Abnormal Child Psychology, 6, 221–236.
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.
Jonsdottir, S., Bouma, A., Sergeant, J. A., & Scherder, E. J. A. (2006). Relationship between neuropsychological mea-
sures of executive function and behavioral measures of ADHD symptoms and comorbid behavior. Archives of Clinical
Neuropsychology, 21, 383–394.
Kaufman, A. S., & Kaufman, N. L. (1993). Kaufman Assessment Battery for Children. Circle Pines, MN: American
Guidance Services.
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.
Lezak, M. D. (2004). Neuropsychological assessment (4th ed.). New York: Oxford University Press.
Mahone, E. M., Hagelthora, K. M., Cutting, L. E., Schuerholz, L. J., Pelletier, S. F., Rawlins, C., Singer, H. S., & Denckla,
M. B. (2002). Effects of IQ on executive function measures in children with ADHD. Child Neuropsychology, 8,
52–65.
Mangeot, S., Armstrong, K., Colvin, A. N., Yeates, K. O., & Taylor, H. G. (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.
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.
Martinussen, R., Hayden, J., Hogg-Johnson, S., & Tannock, R. (2005). A meta-analysis of working memory impairments
in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent
Psychiatry, 44, 377–384.
Mitchell, M., & Miller, S. (2008). Executive functioning and observed versus self-reported measures of functional ability.
The Clinical Neuropsychologist, 22, 471–479.
Murphy, K., & Barkley, R. A. (1996). Prevalence of DSM-IV ADHD symptoms in adult licensed drivers. Journal of
Attention Disorders, 1, 147–161.
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.
Shallice, T., & Burgess, P. W. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114,
727–741.
Trenerry, M., Crosson, B., Deboe, J., & Leber, W. (1989). Stroop Neuropsychological Screening Test. Odessa, FL:
Psychological Assessment Resources.
Valera, E. M., Faraone, S. V., Murray, K. E., & Seidman, L. J. (2007). Meta-analysis of structural imaging findings in
attention-deficit/hyperactivity disorder. Biological Psychiatry, 61, 1361–1369.
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.
Wechsler, D. (1997). Manual for the Wechsler Adult Intelligence Test 3rd Ed. (WAIS–III). San Antonio, TX:
Psychological Corp.
Welsh, M. C., & Pennington, B. F. (1988). Assessing frontal lobe functioning in children: Views from developmental
psychology. Developmental Neuropsychology, 4, 199–230.
Wilcutt, 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.
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.

Barkley2011, Test Vrs Self Reported

Încărcat de

Informații document

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Barkley2011, Test Vrs Self Reported

Încărcat de

Drepturi de autor:

Formate disponibile

This article was downloaded by: [Northeastern University]

On: 19 November 2014, At: 18:11

Predicting Impairment in Major Life

To link to this article: http://dx.doi.org/10.1080/87565641.2010.549877

PLEASE SCROLL DOWN FOR ARTICLE

Predicting Impairment in Major Life Activities

Hyperactivity in children, or attention deficit hyperactivity disorder (ADHD), is associated with

(1) H+ADHD (2) H−ADHD (3) Community Pair-Wise

Group: Measure Mean SD Mean SD Mean SD F p Contrasts

Age (years) 26.8 1.4 27.2 1.4 27.0 0.9 1.83 NS

Measures Used to Screen and Select Participants

Deficits in Executive Functioning Interview (DEFI):. A rating scale of executive dysfunc-

Relationship of EF Tests to DEFI Scales of EF Deficits

Relationship of EF Measures to ADHD Severity

Group Differences in Executive Functioning

(1) ADHD–P (2) ADHD–NP (3) Community Pair-Wise

Group: Measure M SD M SD M SD F p Contrasts

Group Scale 1. ADHD–P 2. ADHD–NP 3. Community X2 p< Contrasts

Self-Activation/Concentration 76 34 17 47.98 <.001 1> 2 > 3

Predicting Impairment in Major Life Activities: DEFI Scales Versus EF Tests

= .41; Self-Organization = .44; Inhibition = .45; Self-Motivation = .37; and Self-Activation =

Overall Adaptive Impairment (self-rated):

Overall Adaptive Impairment (other-rated):

Relationship of DEFI Scales to Occupational Impairments

Occupational Measure SMT SOPS INH SMO SAC

Hollingshead Job Index −.35∗ −.29∗ −.35∗ −.29∗ −.33∗

Relationship of EF Tests to Occupational Impairments

Predicting Impairment in Occupational Functioning: DEFI Scales Versus EF Tests

Hollingshead Job Index:

Hollingshead Job Index:

KHM # correct .209 .209 .044 .044 8.39 .004

activities. We attempted to do so using both self-ratings and other-ratings of adaptive impair-

functioning specifically in samples that vary in severity of ADHD in adulthood.

Archives of Clinical Neuropsychology, 21, 429–437.

S-ar putea să vă placă și