Predicting Impairment in Major Life Activities and Occupational Functioning in Hyperactive Children as Adults: Self-Reported Executive Function (EF) Deficits Versus EF Tests

“(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 straightforward interpretation as pure measures of a particular EF construct.”

“…as individuals with ADHD are typically rated as having more difficulties with everyday tasks presumed to involve executive function processes (Barkley & Fischer, 2011; Barkley & Murphy, 2010a,b, Barkley and Murphy 2011; Biederman et al., 2008; Hummer et al., 2010; Mahone et al., 2002;…”

“The EF test scores also are very poor at predicting impairment in a variety of domains of major life activities, compared to EF behavioural rating scales [125].”

“These studies relied exclusively on tests of EF, which appear to have low ecological validity and low or no relationships to various domains of impairment in contrast to ratings of EF (Barkley, 2012b; Barkley & Fischer, 2011).”

“…difficulties, skills training, contingency management, treatment efficacy Organization, time management, and planning (OTMP) difficulties, features of attention-deficit/hyperactivity disorder (ADHD), adversely affect children’s functioning and persist through adulthood (Barkley & Fischer, 2011).”

“We did not include ratings of EF, which have been hypothesized to be sensitive to dysfunction in ways that neuropsychological tests are not (Barkley and Fischer 2011).”

“For example, some have argued that daily EF deficits in ADHD are not captured by EF laboratory tasks (Barkley & Fischer, 2011; Brown, 2008).”

“…806 W. Franklin Street, Richmond, VA 23284, USA S. W. Evans Ohio University, Athens, OH, USA Executive functions (EF) have received considerable research attention and have been hypothesized to underlie the functional impairments of youth with ADHD (Barkley 2001; Barkley and Fischer 2011).”

“Prior studies have found similar longitudinal associations in samples consisting of mostly males (e.g., Barkley et al. 2006; Barkley and Fischer 2011) but there is a paucity of research on such associations in entirely female samples.”

“One exception is the study by Barkley and Fischer (2011), which showed that, among adults with ADHD, impairment in major life activities and occupational functioning were better predicted by ratings of executive functioning than by laboratory tests.”

“…between EF tests and everyday abilities that are believed to be dependent on well‐functioning executive skills such as academic achievement, social relations, work performance, criminality, and substance abuse (Barkley & Fischer, 2011; Barkley & Murphy, 2010, 2011; Szuromi, Bitter, & Czobor, 2013).”

“However, there are also strong arguments that self-report measures of executive problems are of value (Barkley & Fischer, 2011; Johnco, Wuthrich & Rapee, 2014; Kamradt, Ullsperger & Nikolas, 2014).”

“In one study, remitters performed worse than controls (Bédard et al., 2010), and in two studies, persisters performed worse than controls as well (Barkley & Fischer, 2011; Bédard et al., 2010).”

“Adults with ADHD also experience deficits of executive functioning, which can contribute to impairments in daily life (Barkley and Fischer 2011; Barkley and Murphy 2010).”

“Barkley and colleagues have shown that EFDs are highly impairing (Barkley & Fischer, 2011; Barkley & Murphy, 2010, 2011).”

“These deficits lead to difficulties in academic and occupational functioning, as well as in family and marital relationships (Barkley & Fischer, 2011; Johnston, 2012; Johnston, Mash, Miller, & Ninowski, 2002).”

“Consistent with previous findings (Babinski, Pelham, Molina, Gnagy, et al., 2011; Barkley & Fischer, 2011; Barkley et al., 2006; Brook et al., 2013; Fletcher, 2014; Klein et al., 2012; Kuriyan et al., 2013; Mannuzza et al., 1997), adult outcomes in the occupational domain varied by informant, with…”

“…report typical performance on a range of EF measures (Nigg et al., 2005; Piek, Dyck, Francis, & Conwell, 2007), whereas others find impairment (Barkley & Fischer, 2011; Barkley & Murphy, 2011; Biederman et al., 2008; Sergeant, Geurts, & Oosterlaan, 2002; Toplak, Bucciarelli, Jain, & Tannock,…”

“Thus, some have argued that questionnaire measures may better capture impairments in daily life linked to outcomes such as psychopathology (e.g., Barkley & Fischer, 2011).”

“[27, 28] concluded that rating scales of EF are more likely to predict real-life”

“Support for this view has been found in recent studies involving individuals with typical ADHD, which found functional ratings of executive function to be superior predictors of impairment in daily living skills than tests of executive function (Barkley & Fischer, 2011; Barkley & Murphy, 2010).”

“At the same time, there is limited evidence that laboratory measures of EF reflect everyday functioning (Barkley & Fischer, 2011).”

“Consistent with the established links between ADHD, self-reported impairment in EF, and major life activities found in the adult ADHD literature (Barkley & Fischer, 2011), these post-secondary students self-reported significant impairment related to EF difficulties in daily life.”

“Although behavioral ratings of EF have been argued to have higher ecological validity than performance-based measures of EF (Barkley & Fischer, 2011), a more recent review concluded that both provide important, non-redundant information (Toplak et al., 2013).”

“The core symptoms are inattention, impulsivity, and hyperactivity which cause extensive difficulties in school,(15) work,(16) social,(17) and domestic life.(18) CP is the leading cause of severe physical disability in childhood, characterized by impairments in the development of motor function and posture, it presents…”

“…of the link between neuropsychological deficits and daily life functioning is that relations have been shown to be much stronger when neuropsychological deficits are studied using EF self-ratings rather than EF tests (Barkley & Fischer, 2011; Barkley & Murphy, 2010; Potvin et al., 2016).”

“This has advantages in terms of ecological validity, and some have argued in favor of using questionnaires rather than EF tasks (e.g., Barkley & Fischer, 2011).”

“Daily life EFs refer to behaviors related to self-management of time, self-organization and problem solving, self-discipline, selfmotivation, and self-activation (Barkley & Fischer, 2011).”

“This method is consistent with other follow-up studies of participants with childhood-diagnosed ADHD (e.g., Barkley & Fischer, 2011).”

“Ratings of child selfcontrol are an important predictor for health, wealth, academic, occupational and crime outcomes years later (Barkley & Fischer, 2011; Daly, Delaney, Egan, & Baumeister, 2015; Langberg, Dvorsky, & Evans, 2013; Moffitt et al., 2011).”

“These results are consistent with the suggestion that EF ratings may predict real-world impairment better than laboratory EF tasks (Barkley & Fischer, 2011), although method covariance could also explain the larger correlations between self-reported impulsivity and self-reported symptoms of…”

“Such patterns have been interpreted as evidence that rating scales are better assessments of control deficits than are tasks (Barkley & Fischer, 2011; Eisenberg et al., 2019).”

“Daily life EF includes behaviors related to time management, organization, problemsolving, self-discipline, motivation, and activation (Barkley & Fischer, 2011) and have been shown to be significantly associated with relevant outcomes such as academic performance (Langberg, Dvorsky, & Evans, 2013).”

“Nevertheless, the ADHD-R group had significantly worse scores than the community group (without ADHD) on self-organization, inhibition, and selfactivation [17].”

“, 2004) and have identified two additional areas of concern: occupational functioning, (Barkley and Fischer, 2011) and motor vehicle driving (Jerome et al.”

“Proponents of rating scales argue that such ratings are more ecologically valid and related to adaptive or occupational function (Barkley & Fischer, 2011; Barkley & Murphy, 2010).”

“ADHD is also characterized by cognitive difficulties [6], and impacts significantly on management of daily routines [7], school [8], work [9] and social relationships [10].”

“…EF components on a neuropsychological level while behavior rating scales such as the BRIEF measure global EF on a behavioral level (Pennington, 2002), both approaches are considered valuable and do not exclude one another (Barkley & Fischer, 2011; Gioia, Isquith, Kenworthy, & Barton, 2002).”

“[Wechsler, 1997] or the Tower of London Test [Shallice & Burgess, 1991], both in Barkley & Fischer, 2011).”

“In addition, this is consistent with other ADHD research claiming that laboratory measures of executive functioning have much lower ecological validity compared to ratings as they are poorly related to different aspects of daily life functioning such as educational activities, money management, social interactions and…”

“Thus, early executive control deficits in ADHD appear to persist into adulthood [15], and might be consistent with self- and informant reports regarding behavioral manifestations of executive difficulties in everyday life [24–26].”

“One reason for this is that ratings have been shown to be more strongly related to daily life functioning compared to tests (e.g., Barkley & Fischer, 2011; Barkley & Murphy, 2010).”

“Behavioral manifestations of poor EF are Organization, Time Management, and Planning (OTMP) difficulties, which adversely affect children's functioning and persist through adulthood [2].”

“Far Transfer Measures consisted of: 1) The Cognitive Failures Questionnaire was used to assess self-reported errors in memory, perception, and motor function when completing everyday tasks; the questionnaire has been found to have good external validity and stability over time [38], 2) The Barkley Deficits in Executiv…”

“The BRIEF is thought to provide a picture of idiographic cognitive functioning of an individual (McCandless and O’Laughlin 2007), which differs notably from laboratory-based tasks of EF that may lack real-world ecological validity (Barkley and Fischer 2011; Toplak et al. 2013).”

“Children with EBP, such as those diagnosed with attention-deficit/hyperactivity disorder (ADHD), often experience EF deficits (see Willcutt, Doyle, Nigg, Faraone, & Pennington, 2005, for a review) that are predictive of their impairments in academic functioning (Barkley & Fischer, 2011).”

“Other work has demonstrated little overlap between EF tasks and ratings, particularly, self-report ratings of EF (Barkley & Fischer, 2011; Bogod, Mateer, & MacDonald, 2003; Toplak, West, & Stanovich, 2013).”

“…secondly, that other confounding factors that account for the difference between self-reported and task-based measures of executive functioning (e.g., goals, motivations, and other contextual factors; Barkley & Fischer, 2011; Lin, 2009) may also account for differences involving media multitasking.”

“Others, however, have challenged EF tests as the gold standard for assessing EF deficits (Barkley, 2011, 2012; Barkley and Fischer, 2011; Barkley and Murphy, 2011; Barkley and Murphy, 2010).”

“When utilized in isolation, these measures have yielded conflicting findings and failed to consistently predict group differences (Barkley and Fischer, 2011; Rice and Weyandt, 2000; Shuster and Toplak, 2009).”

“Compared with neuropsychological tests of EF, behavioral assessments may be better predictors of impairment in major life activities [17].”

“But for relatively boring tasks, the difference between the two groups was significant.(51,52) Third, individual difference and the emotional status in ADHD patients during test may also affect the outcome.”

“Interventions for ADHD and Violence ADHD is an impairing [56] lifelong condition in adults and is under-diagnosed and untreated in many European countries [57].”

“Daily life EFs include behaviors related to time management, organization and problem solving, self-discipline, motivation, and activation (Barkley and Fischer, 2011).”

“For the first scenario, several studies (Barkley and Fischer 2011; Barkley and Murphy 2010) have shown that children’s performance on tests in an individual setting is often not strongly predictive to real-world environments (e.”

“Although neuropsychological tests have the advantage of not being influenced by rater bias, they often have poorer ecological validity compared to ratings [29,30].”

“…study, we selected a global, parent-report measure of ADLs because (a) adults with ADHD demonstrate difficulties with daily living skills and ADLs (Barkley & Fischer, 2011; Barkley & Murphy, 2010), and (b) the concurrent validity of these scales has been demonstrated relative to global as well as…”

“Similarly, in a large longitudinal study of youth with hyperactivity, Barkley and Fischer (2011) found that scores from a selfreport measure of EF (Deficits in Executive Function Interview) served as much stronger predictors of ADHD persistence and impairment into adulthood than performance-based…”

“…outside the lab, potential impact of state/contextual factors), Study 2 utilized a self-report questionnaire designed to assess EF in the everyday life and thus potentially capture more pervasive EF difficulties (which may be more predictive of functional impairment; see Barkley & Fischer, 2011).”

“Some previous studies have found that the relation to daily functioning is stronger when executive deficits are measured using self-ratings rather than tests (Barkley & Fischer, 2011; Barkley & Murphy, 2010, 2011).”

“Among studies that have examined IQ among persisters and remitters in adolescence/young adulthood, several found no differences in IQ (Barkley and Fischer, 2011; Mick et al., 2011).”

“Overall, adaptive impairment is highly correlated with the executive dysfunction that is characteristic of ADHD (Barkley and Fischer 2011).”

“Furthermore, previous research has shown that EF selfratings are more sensitive to particular EF related symptoms than neuropsychological tests [46].”