Cited by 413Attention Deficit Hyperactivity DisorderDevelopmental and Educational NeuropsychologyAutism Spectrum Disorder Research

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

Barkley, Russell A., Fischer, Mariellen·2011·Developmental Neuropsychology

DOI 10.1080/87565641.2010.549877

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Abstract

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 control 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 functioning 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 act…

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Ryan, S. V., Power, T. J., Pendergast, L. L., Poznanski, B., Nissley‐Tsiopinis, J., Abikoff, H., Gallagher, R., Tremont, K. L., Cacia, J., & Mautone, J. A. (2024) · School Mental Health · doi:10.1007/s12310-024-09646-w · Cited by 5
“Although these performance-based measures may be useful in identifying deficits in neurocognitive processing, a criticism of these tests is that they lack ecological validity by failing to reflect impairment in daily life (Barkley & Fisher, 2011; Kamradt et al., 2014).”
Combining Performance-Based and Self-Reported Measures of Executive Functions: Are Both Meaningful in Predicting Study Success in Higher Education Students?
Manuhuwa, D. M., Boer, M. S.-D., de Graaf, J. W., & Fleer, J. (2024) · European Journal of Educational Research · doi:10.12973/eu-jer.13.4.1647 · Cited by 8
ADHD and Alcohol Use Disorder: Optimizing Screening and Treatment in Co-occurring Conditions
Hernández, M., LEVIN, F. R., & Campbell, A. N. C. (2025) · CNS Drugs · doi:10.1007/s40263-025-01168-6 · Cited by 6
“Attention-deficit hyperactivity disorder (ADHD) is a highly impairing neurodevelopmental disorder marked by a dysregulation of attention and impulsivity as well as executive function deficits [1].”
Are Perceived Executive Functions Beneficial for Adolescents Who Experience Peer Victimization?
Morea, A., & Calvete, E. (2022) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-022-10005-9 · Cited by 6
“…validity in examining behavior in complex real-world situations (e.g., distractions when performing a particular task) and representative impairments in daily life, as they are not limited to a specific moment in a structured laboratory condition (Barkley & Fischer, 2011; Snyder et al., 2021).”
Background
A comparison of three executive function interventions on direct and far transfer in Chilean school children: a cluster-randomized controlled protocol
Napolitano, N., Rojas‐Barahona, C. A., Gaete, J., & Araya, R. (2025) · BMC Psychology · doi:10.1186/s40359-025-03075-3 · Cited by 7
“EF provide the cognitive foundation for regulating thoughts, emotions and behaviors and have a significant impact on various quality of life outcomes for children and adolescents [11, 12].”
Brain structural changes and the development of interference control in children with ADHD: The predictive value of physical activity and body mass index
Ludyga, S., & Ishihara, T. (2022) · NeuroImage Clinical · doi:10.1016/j.nicl.2022.103141 · Cited by 10
“…with deficits in executive function (Brocki et al., 2010; Landis et al., 2021), which predict delayed school readiness (Pellicano et al., 2017), poor academic performance (Samuels et al., 2016), problems with peers (Holmes et al., 2016), and low occupational functioning (Barkley and Fischer, 2011).”
Background
A longitudinal investigation of parental ratings and performance metrics for executive functioning and symptom severity in clinically referred youth with ADHD
Tallberg, P., Råstam, M., Hallin, A., Perrin, S. G., & Gustafsson, P. (2022) · Applied Neuropsychology Child · doi:10.1080/21622965.2022.2093113 · Cited by 7
The effect of background sounds on mind wandering
Alali-Morlevy, K., & Goldfarb, L. (2022) · Psychological Research · doi:10.1007/s00426-022-01751-2 · Cited by 6
“ADHD-related symptoms 1 3 are characterized by inattentive behaviors alone, hyperactive and impulsive behavior alone, or a combination of both inattention and hyperactivity (e.g., Barkley & Fischer, 2011; Johnston, 1998; Johnston et al., 2012; Polanczyk & Rohde, 2007).”
Background
Executive control training for adolescents with ADHD: Study protocol for a randomised controlled trial
Dyresen, A., Stubberud, J., Fjermestad, K. W., Haugen, I., & Øie, M. G. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107404 · Cited by 5
Cognitive control impairment in adult with attention deficit/hyperactivity disorder
Chutko, L. S., Surushkina, S. Y., Yakovenko, E. A., Анисимова, Т. И., Antokhin, E. Y., & Kryukova, E. A. (2018) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro201811812131 · Cited by 5
Is Neuropsychological Testing Useful for Any Reason in the Evaluation of ADHD? A Rejoinder to Mapou
Barkley, R. A., & Eme, R. F. (2019) · The ADHD Report · doi:10.1521/adhd.2019.27.5.1 · Cited by 5
Self-citation
Return to Work in Mild Cognitive Disorders
Ettenhofer, M. L., Stavro, G. M., & Melrose, R. J. (2015) · Handbooks in health, work, and disability · doi:10.1007/978-1-4899-7627-7_31 · Cited by 5
The Role of Executive Functioning Deficits in the Association between Substance-use-Related Stigma and Substance use Problems among Trauma-Exposed Individuals
Wang, K., Schick, M. R., & Weiss, N. H. (2021) · Substance Abuse · doi:10.1080/08897077.2021.1903652 · Cited by 3
How to foster learning by limiting the response speed
Casadevante, C., Ortner, T. M., Romero, M., Hernández, J. M., & Santacreu, J. (2021) · Current Psychology · doi:10.1007/s12144-021-01784-7 · Cited by 4
“A large number of authors have pointed out that some of these academic difficulties are related to a lack of self-regulation (Barkley, 2012; Barkley & Fischer, 2011; Naglieri & Das, 2005; Núñez et al., 1998; Rosário et al., 2005; Schunk & Zimmerman, 1998; Zimmerman, 2002).”
Background
Parent Training for ADHD: No Generalization of Effects From Clinical to Neuropsychological Outcomes in a Randomized Controlled Trial
Lambek, R., Sonuga-Barke, E. J. S., Lange, A., Carroll, D. J., Daley, D., & Thomsen, P. H. (2022) · Journal of Attention Disorders · doi:10.1177/10870547221130108 · Cited by 4
“It could of cause also be posited that neuropsychological tasks are themselves not very accurate indicators of everyday function and therefore also biased (Barkley & Fischer, 2011).”
Background
The Pictorial Interview of Children’s Metacognition and Executive Functions (PIC-ME): Cultural Adaptation for Ultra-Orthodox Jewish Populations
Golos, A., Budman, J. R., Shterenshus, A., & Bar-Ilan, R. T. (2023) · Occupational Therapy International · doi:10.1155/2023/4832354 · Cited by 4
Development of a Cognitive-Behavioral Treatment for Adult ADHD
Solanto, M. V., Marks, D. J., & Wasserstein, J. (2011) · The ADHD Report · doi:10.1521/adhd.2011.19.1.7 · Cited by 4
“…this approach in documenting that problems in the inattentive domain (Safren, Sprich, Cooper-Vince et al., 2010) and executive function domain (Barkley & Fischer, 2010) of symptoms are more highly associated with impairment for adults with ADHD than those which emerge from the…”
Background
Diagnosis and treatment of cognitive impairment in adults with attention deficit hyperactivity disorder
Chutko, L. S., Surushkina, S. Y., Yakovenko, E. A., Kropotov, J. D., & Сергеев, А. В. (2017) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro2017117519-13 · Cited by 4
The Quantified Behavioural Test Plus (QbTest+) in adult ADHD
Nylander, E., Sparding, T., Floros, O., Rydén, E., Landén, M., & Hansen, S. (2022) · Nordic Psychology · doi:10.1080/19012276.2022.2036628 · Cited by 4
“A final possibility is that self-reports versus objective tests capture different, albeit related, cognitive endophenotypic levels and the assessment goal determining the appropriate measuring method (see Barkley & Fischer, 2011).”
Method
Autism traits and real-world executive functioning in parents of children with disabilities and undergraduates
Camodeca, A. (2022) · Current Psychology · doi:10.1007/s12144-022-04097-5 · Cited by 4
“Those with the BAP will demonstrate higher a) means and b) proportion of scores in the clinically significant range, with the exception of Organization of Materials and Inhibition.”
BackgroundInfluential
Evaluation of an Executive Functioning Test Battery in Two Versions with Material Close to Daily Life
Kallweit, C., & Exner, C. (2016) · Zeitschrift für Neuropsychologie · doi:10.1024/1016-264x/a000191 · Cited by 4
Theories of Intelligence
Euler, M. J., & McKinney, T. L. (2019) · Autism and child psychopathology series · doi:10.1007/978-3-030-20843-1_2 · Cited by 5
Konstrukt- und Kriteriumsvalidität einer deutschen Version des Behavior Rating Inventory of Executive Function (BRIEF) zur Identifikation von Kindern mit Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörungen (ADHS)
Schöfl, M., Beitel, C., Kloo, D., & Kaufmann, L. (2014) · Diagnostica · doi:10.1026/0012-1924/a000103 · Cited by 4
Neuropsychological Functioning and Psychosocial Outcome in Adults with Attention-Deficit/ Hyperactivity Disorder
Sobanski, E., Sirtl, A., Alm, B., Hennig, O., & Banaschewski, T. (2015) · Zeitschrift für Neuropsychologie · doi:10.1024/1016-264x/a000129 · Cited by 4
Attention deficit hyperactivity disorder: Behavioral report from professors and self-report from university students.
Ramos-Galarza, C., Fiallo-Karolys, X., Rámos, V., Jadán-Guerrero, J. L., & Paredes-Núñez, L. (2018) · Psychology & Neuroscience · doi:10.1037/pne0000124 · Cited by 4
Attention‐Deficit/Hyperactivity Disorder in Adults
Knouse, L. E., & Safren, S. A. (2013) · Wiley eBooks · doi:10.1002/9781118528563.wbcbt32 · Cited by 4
Executive Functions and Resilience in First-Year Undergraduate Students
McKee, J. (2017) · Libraries and Cultural Resources (University of Calgary) · doi:10.11575/prism/26037 · Cited by 5
The Canadian COVID-19 Experiences Project: Design and ProtocolPreprint
Hall, P. A., Fong, G. T., Hitchman, S. C., Quah, A. C. K., Agar, T. K., Meng, G., Ayaz, H., Doré, B., Sakib, M. N., Hudson, A., et al. (2021) · medRxiv · doi:10.1101/2021.12.24.21268387 · Cited by 4
Executive functioning in adults with attention deficit hyperactivity disorder: A systematic review
Rincón-Lozada, C. F., Morales, L. B., & Sandoval, S. T. (2024) · Acta neurológica colombiana · doi:10.22379/anc.v40i3.1208 · Cited by 6
Attention and target shooting practice: Longitudinal results in a controlled mixed method study on adolescents in Norway
Løhre, A., Østerlie, O., Hjemdal, O., & Grambaitė, R. (2022) · International Journal of Educational Research Open · doi:10.1016/j.ijedro.2022.100154 · Cited by 3
Young Adult ADHD Symptoms in the General Population and Neurocognitive Impairment
Agha, S. S., Riglin, L., Carbury, R., Blakey, R., Shakeshaft, A., Thapar, A. K., Tilling, K. M., Collishaw, S., Stergiakouli, E., Thapar, A., et al. (2023) · Journal of Attention Disorders · doi:10.1177/10870547231201870 · Cited by 4
“Those with ADHD and executive function deficits, on average, show greater impairment in occupational functioning and academic achievement compared to those with ADHD without EF deficits and to controls (without ADHD) (Barkley & Fischer, 2011; Barkley & Murphy, 2011; Halleland et al., 2019).”
Background
Adult Persons with ADHD and Their Lifestyle
Björk, A., Rönngren, Y., & Våge, L. (2023) · Autism and child psychopathology series · doi:10.1007/978-3-031-41709-2_7 · Cited by 3
The Rey-Osterrieth Complex Figure: A useful measure of organizational skills for adolescents with ADHD?
Molitor, S. J., Eadeh, H., Bourchtein, E., Smith, Z. R., Green, C. D., & Langberg, J. M. (2018) · Journal of Pediatric Neuropsychology · doi:10.1007/s40817-018-0055-6 · Cited by 4
Evaluación del funcionamiento ejecutivo y habilidades adaptativas en un niño de 11 años con diagnóstico de TEA en comorbilidad con TDAH: un estudio de caso
Gutiérrez-Ruiz, K., Iriarte, D. C. C., & Mendoza, A. H. (2020) · Tesis Psicológica · doi:10.37511/tesis.v15n1a4 · Cited by 5
Objective Income But Not Subjective Social Status Predicts Short-Term and Long-Term Cognitive Outcomes: Findings Across Two Large Datasets
Oh, V. Y. S., Yu, Z., & Tong, E. M. W. (2021) · Social Indicators Research · doi:10.1007/s11205-021-02844-y · Cited by 3
“For example, impairments in aspects of executive function have been linked to poorer occupational functioning (Barkley & Fischer, 2011) and job burnout (Schmidt et al., 2007), and cognitive ability is often found to be a strong predictor of job performance (Schmidt & Hunter, 2004).”
Background
The Role of Executive Function in Impulsive Consumer Purchasing Behavior
Adams, H. M. (2019) · Digital Archive @ GSU · doi:10.57709/14972830 · Cited by 3
Measuring Organizational Skills in the General Population: Development and Preliminary Validation of the DOSQPreprint
Durand, G. (2020) · Preprints.org · doi:10.20944/preprints202008.0376.v1 · Cited by 3
“…skills in children also result in procrastination and failure to organize, prioritize, and plan academic-related tasks; these problems increase throughout adolescence (Booster, DuPaul, Eiraldi, & Power, 2012; Langberg et al., 2010) and continue into adulthood (Barkley & Fischer, 2011).”
Background
Input lingüístico de madres y padres y producción lingüística en niños y niñas de 3 años de edad durante el juego
Aldoney, D., Mendive, S., Zegers, M., Prieto, F., & Pérez, J. C. (2024) · Revista Iberoamericana de Psicología · doi:10.33881/2027-1786.rip.17106 · Cited by 2
YÜRÜTÜCÜ İŞLEVLER ÖLÇEĞİNİN GELİŞTİRİLMESİ: GEÇERLİLİK GÜVENİRLİK ÇALIŞMASI
Gür, G. C., & Öztürk, F. Ö. (2024) · Karadeniz Uluslararası Bilimsel Dergi · doi:10.17498/kdeniz.1512772 · Cited by 2
“Nitekim çalışmalarda yürütücü işlevlerin laboratuvar ölçümleri ile teorik olarak bu süreçlere bağlı olan beceriler arasında zayıf bir ilişki olduğu gösterilmiştir(Barkley and Fischer 2011; Barkley and Murphy 2011).”
Academic Skills Training Interventions for Adolescents in Secondary Education: A Systematic Review
Wolters, K., der Oord, S. V., Psyllou, C., van den Hoofdakker, B. J., & Boyer, B. E. (2025) · School Psychology Review · doi:10.1080/2372966x.2025.2548763 · Cited by 2
“In the longer term, adequate academic skills may prevent psychosocial, occupational, and economic difficulties (Barkley & Fischer, 2011; Diamantopoulou et al., 2007; Galéra et al., 2012; Huisman et al., 2005; Kuriyan et al., 2013).”
The Relationship Between Organization in Time, Executive Functions, and Quality of Life in Adult ADHD
Grinblat, N., & Rosenblum, S. (2025) · Brain Sciences · doi:10.3390/brainsci15121262 · Cited by 5
A Secondary Analysis of Longitudinal Pilot‐Study Data Investigating the Associations Between Health‐Related Quality of Life and Executive Functions in Remitted Major Depressive Disorder and Developments Two‐Years Following Cognitive Training
Ronold, E. H., Storfossen, S. K., Vignes, M. V., & Hammar, Å. (2025) · Scandinavian Journal of Psychology · doi:10.1111/sjop.70060 · Cited by 2
“…context of objective neuropsychological assessment (Snyder et al. 2021), and thus be more related to daily activities like occupational functioning (Barkley and Fischer 2011), which are proposed to be more closely related to HRQL. Findings are in line with studies showing small associations…”
The Impact of Executive Functions on Metaphonological Skills: Correlation and Treatment Implication for ADHD Children
Piccolo, A., Fauci, M. L., Domenico, C. D., Cara, M. D., Fulgenzi, A., Mancuso, N., Bonanno, L., Tresoldi, M., Muratore, R., Impallomeni, C., et al. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15020906 · Cited by 3
“ADHD is often associated with a substantial burden for individuals and their families, and may negatively affect academic performance, social interactions, and perceived quality of life [4,5].”
Executive Function Associated to Symptoms of Attention Deficit Hyperactivity Disorder and Paediatric Bipolar Disorder
Jiménez, E. A. A., Ballabriga, M. C. J., Bonillo, A., & Arrufat, F. J. (2015) · Psicologia Reflexão e Crítica · doi:10.1590/1678-7153.201528313 · Cited by 2
“On the other hand, it is important to mention that this study only used the BRIEF instrument to assess the EF, because, based on the study of Barkley and Fischer (2011), self-reports of EF are able to measure defi cits in daily activities and in occupational functioning of children and adolescents.”
Method
Alternative Measurement Instrument to Evaluate Executive Functions in Children of All Scholar Range
Ortega, S. V. M., & Sarria-Paja, M. (2019) · Symposium on Image, Signal Processing and Artificial Vision (STSIVA) · doi:10.1109/stsiva.2019.8730230 · Cited by 2
“Alterations of executive functions are key to diagnosis different disorders like attention deficit with hyperactivity [1], autism spectrum disorder (ASD) or autism spectrum condition (ASC) [2], reading comprehension failures [3], inhibitory control [4] and the work memory problems [5].”
Background

Authors: Barkley, R. A., & Fischer, M.
Affiliations: Medical University of South Carolina (US)
Medical College of Wisconsin (US)
Corresponding author: Barkley, Russell A.
Venue: Developmental Neuropsychology
Publisher: Informa UK Limited
Published: 2011-01-31
Volume: 36
Issue: 2
Pages: 137-161
ISSN: 1532-6942 (ISSN-L)
8756-5641
DOI: 10.1080/87565641.2010.549877
OpenAlex: W2116091704
Cited by: 413
References: 45
Citations by year: 2026: 14 · 2025: 26 · 2024: 19 · 2023: 23 · 2022: 35 · 2021: 32 · 2020: 41 · 2019: 27 · 2018: 28 · 2017: 21 · 2016: 29 · 2015: 31 · 2014: 34 · 2013: 26 · 2012: 14
FWCI: 18.60
Type: journal article
Language: en
Open access: closed
Locations: Developmental Neuropsychology (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Mental Health (R01MH042181, MH42181)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords: attention deficit hyperactivity disorder, executive dysfunction, major life activities, occupational functioning, hyperactive children, longitudinal follow-up, work history
MeSH terms: Activities of Daily Living, Adult, Attention Deficit Disorder with Hyperactivity, Cognition Disorders, Female, Humans, Inhibition, Psychological, Interview, Psychological, Longitudinal Studies, Male, Neuropsychological Tests, Occupations, Predictive Value of Tests, Psychiatric Status Rating Scales, Severity of Illness Index, Statistics as Topic, Executive Function, Self Report

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

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