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Cited by 468Attention Deficit Hyperactivity DisorderDevelopmental and Educational NeuropsychologyHistorical and Modern Theater Studies

Impairment in Occupational Functioning and Adult ADHD: The Predictive Utility of Executive Function (EF) Ratings Versus EF Tests

Open access
Barkley, R. A., Murphy, K. R.·2010·Archives of Clinical Neuropsychology
DOI 10.1093/arclin/acq014PMC PMC2858600
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Abstract

Adult ADHD study finding EF ratings predicted occupational impairment more consistently than EF tests, illustrating the ecological validity gap between performance tests and daily functioning ratings.

AI snapshot

Written from the paper’s full text.

TL;DR

In adults ranging from diagnosed ADHD to clinical and community controls, self-rated executive function deficits predicted occupational impairment across all 11 outcomes, whereas EF tests predicted fewer outcomes and usually less variance. The authors argue that EF ratings and EF tests may assess different levels of a hierarchical EF construct, with ratings better capturing daily-life occupational adjustment.

Key findings

  • Across the combined sample (ADHD n = 146; clinical controls n = 97; community controls n = 109), self-ratings on the Deficits in Executive Functioning Scale (DEFS) significantly predicted all 11 occupational measures. Explained variance was 5%–22% for most outcomes, but 63% for the clinician-rated SOFAS; Self-Management to Time, Inhibition/Self-Discipline, and Self-Motivation each predicted five measures.
  • When EF tests were examined alone, only three test scores from two tests made significant contributions. CPT Commission Errors was the most frequent predictor, contributing 1.6%–12.9% of variance; Five-Point Test unique designs contributed 7% to employer-rated impairment, 7.5% to employer-rated work performance, and 3.7% to SOFAS; CPT reaction time contributed 1.7% and 2.8% to two outcomes. No EF test significantly predicted the percentage of jobs from which participants had been fired.
  • In joint analyses, DEFS entered first predicted 10 of 11 occupational measures, while EF tests added unique variance to only 1 of 11. With reversed entry, EF tests predicted 3 measures and DEFS predicted 9. For SOFAS, DEFS explained 45%–67% of variance depending on entry order, while EF tests added only 2% after DEFS. Employer-rated impairment and work performance together reached 40% and 46% explained variance, but neither battery’s contribution was significant because of small employer-rated samples.

Methods

  • Three groups were combined: 146 adults clinically diagnosed with ADHD, 97 clinic-referred adults not diagnosed with ADHD, and 109 community volunteers. Eligibility required IQ ≥ 80 on the Shipley Institute of Living Scale and excluded significant sensory, neurological, language, medical, or psychiatric conditions specified in the paper; community controls also scored below the 84th percentile on current Adult ADHD Rating Scale self-report.
  • Occupational outcomes came from a structured impairment interview (job number, work quality, being fired, interpersonal and behavioral job problems, quitting due to boredom or hostility, discipline for substandard work), employer ratings (available for 39 ADHD, 25 clinical control, and 50 community control participants), and clinician SOFAS ratings. Predictors were DEFS self-ratings (88 items, five subscales) and EF tests including CPT, Stroop, Wisconsin Card Sort, Five-Point Test, and Digit Span.
  • Linear multiple regression was used: IQ was forced in at Step 1, then DEFS subscales or EF tests entered stepwise at Step 2. Joint models entered all DEFS and all EF tests battery-wise in both possible orders.

Limitations

  • The paper states that the DEFS item pool may not have captured every possible EF dimension, the EF test battery was relatively circumscribed, occupational history relied partly on self-report subject to recall bias, employer ratings were available only for a subset and were a crude index, and combining clinical and community groups may have inflated relationships and limits generalizability.
  • The paper also notes that employer-rated analyses were underpowered because of small samples, so some nonsignificant joint contributions may reflect limited power rather than true absence of effect.
  • Evident from the text: the design is cross-sectional and correlational, so causal direction between EF deficits and occupational impairment cannot be established; medication status was not fully controlled, although the authors report no significant severity differences between medicated and unmedicated clinical participants.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/arclin/acq014

Cites

58 of 58 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

7 of 59 cited sources checked · 1 supported · 2 flagged · accuracy not yet measured

  • Premisecitation

    The variance shared between any single EF test and EF ratings typically ranges from 0% to 10%.

    “These studies typically find that the variance shared between any single EF test and EF ratings ranges from just 0% to 10%.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Burgess et al., 1998 source

      In the section “Correlations Between Overall Severity of Dysexecutive Disorder and the Neuropsychological Test Measures” (Table 2; page unavailable), eight of ten executive-test measures correlate with carers’ DEX ratings at r = .35–.40. Squaring those correlations gives approximately 12%–16% shared variance, contrary to the claimed typical range of 0%–10%. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites Chaytor et al., 2006 source
    • cites Wood & Liossi, 2006 source
  • Premisecitation

    EF tests have low or no ecological validity when judged against ratings of EF in daily life or direct observations of EF performance in natural settings.

    “Most troubling from a clinical perspective is that EF tests have low or no ecological validity when judged against ratings of EF in daily life or direct observations of EF performance in natural settings.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Burgess et al., 1998 source

      The Discussion (page unavailable) says executive-test performance consistently correlated with observers’ ratings of patients’ everyday dysexecutive problems. The Results section, “Correlations Between Overall Severity of Dysexecutive Disorder and the Neuropsychological Test Measures” (page unavailable), calls the relationships nontrivial. The study used questionnaires rather than direct observations in natural settings. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites Chaytor et al., 2006 source
    • cites Wood & Liossi, 2006 source
  • Premisecitation

    Deficits on EF tests are usually only weakly related to severity of ADHD symptoms, if at all.

    “Moreover, such deficits on EF tests are usually only weakly related to severity of ADHD symptoms, if at all”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Barkley et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Jonsdottir et al., 2006 source
  • Interpretationcitation

    The constructs evaluated by EF tests are apparently not those assessed by EF ratings or by direct evaluations of EF in daily life.

    “The constructs evaluated by EF tests are apparently not those assessed by EF ratings or by direct evaluations of EF in daily life”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites Alderman et al., 2003 source

      In ‘Relation between MET-SV and other executive function tests in patients’ (p. 9), many patients passed traditional EF tests but failed the shopping task, and their shopping-task errors correlated with observer ratings of everyday executive symptoms. This supports a distinction between the traditional tests studied and everyday functioning, but not the broader claim that EF tests generally assess different constructs from ratings or direct daily-life evaluations: the paper’s own MET-SV is an EF test that aligns with those ratings. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites Shallice & Burgess, 1991 source
  • Premisecitation

    Past studies found EF tests to have low-order correlations that are often nonsignificant with patient self-ratings and significant others' ratings of dysexecutive symptoms in patients with frontal lobe injuries.

    “Past studies found EF tests to have low-order correlations that are often nonsignificant with patient self-ratings and those of significant others of the dysexecutive symptoms they observe in patients with frontal lobe injuries”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Burgess et al., 1998 source

      In 'Correlations Between Overall Severity of Dysexecutive Disorder and the Neuropsychological Test Measures' (page not available), the paper reports that test scores generally did not correlate significantly with patients’ self-ratings. But that section reports significant correlations with carers’ ratings, and the Discussion says executive tests consistently correlated significantly with observers’ ratings. The study also examined mixed-etiology neurological patients, not specifically patients with frontal lobe injuries. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites Chaytor et al., 2006 source
    • cites Wood & Liossi, 2006 source
  • May combine two claims. 42
  • Classified as probably not a substantial claim. 31

  • May combine two claims.

    Findingown data

    Several tests of EF were also predictive of occupational adjustment impairments, but they contributed substantially less than EF ratings, particularly when analyzed jointly with the ratings.

    “Although several tests of EF also did so, they contributed substantially less than did the EF ratings, particularly when analyzed jointly with the ratings.”
    • Also stated in: § Abstract · plain
      “Ratings of EF in daily life contribute more to such impairments than do EF tests”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The 5-Point Test score for number of unique designs contributed significantly to three measures: employer rated impairment (7%), employer rated work performance (7.5%), and the clinician SOFAS rating (3.7%).

    “The 5-Point Test score for number of unique designs contributed significantly to three measures, these being, employer rated impairment (7%), employer rated work performance (7.5%), and the clinician SOFAS rating (3.7%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In comparison, when examined individually and apart from the EF ratings, just three EF test scores (two tests) made significant contributions to the occupational measures, the two most frequent being CPT Commission Errors and the 5-Point Test Unique Designs score.

    “In comparison, when examined individually and apart from the EF ratings, just three EF test scores (two tests) made significant contributions to the occupational measures, the two most frequent being CPT Commission Errors and the 5-Point Test Unique Designs score.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Four of the five DEFS scales were not significantly correlated with IQ in this study (rs ranging from .03 to .10), but IQ was correlated with a small but significant degree with the Self-Organization/Problem-Solving scale (r = .15, p = .007, n = 342).

    “Four of the five scales were not significantly correlated with IQ in this study (rs ranging from .03 to .10) but IQ was correlated with a small but significant degree with the Self-Organization/Problem-Solving scale (r ¼ .15,p ¼ .007,n ¼ 342).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Problems with Self-Management to Time, Inhibition, and Self-Motivation were predictive of five measures each, though not necessarily the same occupational measures.

    “In contrast, problems with Self-Management to Time, Inhibition, and Self-Motivation were predictive of five measures each, though not necessarily the same occupational measures.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The DEFS contributed 8% -27% of the variance to these measures of workplace adjustment and 67% of the variance in the clinician SOFAS rating.

    “The DEFS contributed 8% -27% of the variance to these measures of workplace adjustment and 67% of the variance in the clinician SOFAS rating.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Although not significant in their contributions to most impairment measures, the EF tests contributed 2% -27% additional variance but just 2% to the clinician SOFAS rating.

    “Although not significant in their contributions to most impairment measures, the EF tests contributed 2% -27% additional variance but just 2% to the clinician SOFAS rating.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    When the EF ratings and tests were examined jointly, the EF ratings contributed significantly to 10 of the 11 occupational measures when entered first and to 9 of them when entered second.

    “When the EF ratings and tests were examined jointly to evaluate their unique contributions to the occupational measures, the EF ratings contributed significantly to 10 of the 11 occupational measures when entered first and to 9 of them when entered second in the regression analyses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Three DEFS were especially useful in these predictions: Self-Discipline (Inhibition), Self-Management to Time, and Self-Motivation, with each contributing to five different occupational measures.

    “Three DEFS were especially useful in these predictions, these being Self-Discipline (Inhibition), Self-Management to Time, and Self-Motivation with each contributing to five different occupational measures.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Entering the DEFS subscales first and then the EF tests, the DEFS subscales made a significant contribution to 10 of the 11 occupational measures while the EF tests contributed significant and additional unique variance to just 1 of those 11 occupational measures.

    “Entering the DEFS subscales first and then the EF tests, the findings indicated that the DEFS subscales made a significant contribution to 10 of the 11 occupational measures while the EF tests contributed significant and additional unique variance to just 1 of those 11 occupational measures.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    IQ was not significantly related to 10 of the 11 occupational measures but was significantly associated with the percentage of jobs participants had quit due to hostility with their employer.

    “IQ was not significantly related to 10 of the 11 occupational measures but was significantly associated with the percentage of jobs participants had quit due to hostility with their employer.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The CPT Commission Errors is typically interpreted as a measure of inhibition and contributed to various occupational impairments related to behavior, interactions with others, boredom, and hostility as well as to the number of jobs held since high school.

    “The first is typically interpreted as a measure of inhibition and contributed to various occupational impairments related to behavior, interactions with others, boredom, and hostility as well as to the number of jobs held since high school.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Across all participants, self- and other-ratings on the five DEFS scales were significantly correlated, with correlations ranging from .66 to .79 (all p < .001).

    “The relationship of the self-to other ratings was established based on all participants collapsed across groups.They were: Self-Management to Time ¼ .79(p , .001),Self-Organization ¼ .66(p , .001),Inhibition Problems ¼ .74(p , .001),Self-Motivation ¼ .69(p , .001), and Self-Activation/Concentration ¼ .75(p , .001).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    When the EF tests were entered first, they contributed to just two additional occupational measures, whereas the EF ratings continued to contribute unique variance to the majority of those measures.

    “When the EF tests were entered first, they contributed to just two additional occupational measures, whereas the EF ratings continued to contribute unique variance to the majority of those measures.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both the EF ratings and the EF tests contributed substantially to employer rated impairment (40% of the variance) and work performance (46% of the variance) but neither contribution reached significance due to the small samples on which we had employer ratings.

    “Interestingly, both the EF ratings and the EF tests contributed substantially to employer rated impairment (40% of the variance) and work performance (46% of the variance) but neither contribution reached significance due to the small samples on which we had employer ratings.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    Adult occupational functioning is expected to be influenced by EF because effective work performance requires self-management relative to time, self-organization, planning, problem-solving, self-activation, and self-motivation.

    “Of all the domains of major life activities expected to be influenced by EF, adult occupational functioning would be expected to be one of those given its heavy emphasis on the need for the cross-temporal organization and maintenance of behavior and problem-solving toward goals across days, weeks, or even months.”
    • Also stated in: § Introduction · hedged
      “Effective performance at work requires the capacity for self-management relative to time (time management), self-organization planning and problem-solving, selfactivation, and self-motivation to sustain the pursuit of larger delayed consequences over smaller more immediate ones (deferred gratification), among other activities, that are presumed to be facilitated by the EFs.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The definition of EF is quite ambiguous with little or no consensus among researchers.

    “This presumption is problematic for various reasons, not the least of which is that the definition of EF is quite ambiguous with little or no consensus among researchers”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Castellanos et al., 2006 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Research examining EF deficits at the individual level reports that EF deficits exist in just a minority (30%-50%) of ADHD cases.

    “But research examining these deficits at the individual level of analysis (such as percent impaired or abnormal on the test) reports that EF deficits exist in just a minority (30% -50%) of cases”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Biederman et al., 2006 source
    • cites Nigg et al., 2005 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Increasing evidence indicates that adult ADHD is associated with various problems in occupational functioning.

    “Increasing evidence indicates that adult ADHD is associated with various problems in occupational functioning.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Barkley et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites De Quiros & Kinsbourne, 2001 source
    • cites Halmoy et al., 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Compared with either control group of adults, the adults with ADHD were rated as being more impaired by their symptoms in performing assigned work, pursuing educational activities at work, being punctual, using good time management, and managing their daily responsibilities.

    “Compared with either control group of adults, the adults with ADHD were rated as being more impaired by their symptoms in performing assigned work, pursuing educational activities at work, being punctual, using good time management, and managing their daily responsibilities.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Barkley et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationreasoning

    If predicting occupational impairment is an important aspect of the validity of EF measures, then EF ratings were superior to EF tests in doing so.

    “If predicting occupational impairment is an important aspect of the validity of EF measures, then EF ratings were superior to EF tests in doing so.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    These relationships are substantial implying sizeable shared variance between the ADHD and EF constructs if not colinearity.

    “These relationships are substantial implying sizeable shared variance between the ADHD and EF constructs if not colinearity (essentially assessing the same constructs).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Prior work found the ADHD group to be significantly worse than the community control group on all CPT scores and worse than the clinical control group on Omission errors and RT variability.

    “We previously reported the group differences on this test (reference withheld for blind review) where we found the ADHD group to be significantly worse than the community control group on all scores and worse than the clinical control group on Omission errors and RT variability.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites reference withheld for blind review

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductown data

    The subsets of each group on whom employer ratings were obtained are representative of their larger group in demographic factors and ADHD severity, with the exception that within the clinical control group, employer ratings were obtained on a larger proportion of women.

    “With this one exception, it appears that the subsets of each group on whom we obtained employer ratings are representative of their larger group in demographic factors and ADHD severity.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    This was the only occupational measure related to IQ and so it may be the involvement of IQ in the EF tests that led to this contribution.

    “Recall that this was the only occupational measure related to IQ and so it may be the involvement of IQ in the EF tests that led to this contribution.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Prior work found significant differences among ADHD, clinical control, and community control groups on all five DEFS scales, with the ADHD group rated as having more severe executive dysfunction than both control groups and the clinical group rated worse than the community group.

    “We previously reported significant differences among these three groups on all five scales of both versions (Barkley & Murphy, 2009).The ADHD group was rated as having more severe executive dysfunction mean scores on all five scales compared with both the clinical and community control groups, with the clinical group also being rated worse than the community group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barkley & Murphy, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Nonverbal working memory may be more impaired in ADHD than verbal working memory and thus may contribute more to inattention in ADHD.

    “Nonverbal working memory may be more impaired in ADHD than verbal working memory (Martinussen et al., 2005) and thus may contribute more to inattention in ADHD which may explain the utility here of a nonverbal working memory test to predict workplace problems possibly associated with inattention.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Martinussen et al., 2005 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior work found significant group differences for most of the memory retention scores from the Learning and Memory Battery.

    “We found significant group differences for most of the memory retention scores from this test and have reported the group differences for this entire test battery elsewhere (Barkley et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barkley et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    These findings also agree with the study by Mitchell and Miller (2008) that found that EF tests were only modestly related to both ratings and observations of daily functional activities.

    “These findings also agree with the study by Mitchell and Miller (2008) that found that EF tests were only modestly related to both ratings and observations of daily functional activities.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mitchell and Miller, 2008 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior work found significant group differences on the 5-Point Test score among these three groups.

    “We have previously reported significant group differences on this test score among these three groups (Barkley et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barkley et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The EF battery used in this study does not provide comprehensive or exhaustive coverage of all constructs attributed to EF, such as planning and problem-solving and emotional-motivational self-regulation.

    “This battery does not provide a comprehensive or exhaustive coverage of all constructs that have been attributed to EF, such as planning and problem-solving and emotional-motivational self-regulation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Employers were kept blinded to the diagnosis of the participants.

    “Employers were kept blinded to the diagnosis of the participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    These results are consistent with current views that working memory may contribute to some of the inattention symptoms seen in ADHD and thus to workplace problems related to inattention.

    “These results are consistent with current views that working memory may contribute to some of the inattention symptoms seen in ADHD (Barkley, 1997(Barkley, /2001) and thus to workplace problems related to inattention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barkley, 1997/2001

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premiseown data

    In earlier comparisons, the ADHD group performed worse than both the clinical and community groups on the Digit Span subtest, who did not differ from each other.

    “In our earlier comparisons of these groups on this specific subtest, we found the ADHD group to perform worse than both the clinical and community groups who did not differ from each other.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barkley et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    These results suggest that a few EF tests add some unique variance to the prediction of occupational adjustment beyond that contribution predicted by EF ratings, but the contribution is relatively small.

    “These results suggest that a few EF tests add some unique variance to the prediction of occupational adjustment beyond that contribution predicted by EF ratings, but the contribution is relatively small.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Across the five DEFS scales, 89% -94% of the ADHD group, 84% -98% of the clinical control group, and just 7% -11% of the community group fell in the clinically impaired range.

    “About 89% -94% of the ADHD group fell in the clinically impaired range (þ1.5 SD above the mean of the community group) across these five scales as did 84% -98% of the clinical control group and just 7% -11% of the community group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Barkley & Murphy, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Patients with frontal lobe dysfunction have a significantly higher percentage of perseverative errors than do neurological patients without frontal involvement and psychiatric patients.

    “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).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lee et al., 1997 source

  • May combine two claims.

    Interpretationown data

    In sum, although it does appear that EF tests do contribute to a few of the occupational impairment measures, the EF ratings capture most of that contribution as well, contribute to the majority of such measures, and usually contribute more unique variance to them than do the EF tests.

    “In sum, although it does appear that EF tests do contribute to a few of the occupational impairment measures, the EF ratings capture most of that contribution as well, contribute to the majority of such measures, and usually contribute more unique variance to them than do the EF tests.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    EF ratings predict significant variance in the majority of occupational adjustment measures and often do so beyond that variance captured by EF tests.

    “EF ratings, in contrast, predict significant variance in the majority of occupational adjustment measures and often do so beyond that variance captured by EF tests.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Using a modified version of the 5-Point Test, Ruff et al. (1994) found the task to be sensitive to frontal lobe injuries and perhaps more sensitive to right than left lobe involvement.

    “Using a modified version of this same task, Ruff, Allen, Farrow, Nieman, and Wylie (1994) also found the task to be sensitive to frontal lobe injuries and perhaps is more sensitive to right than left lobe involvement.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ruff et al., 1994 source

  • May combine two claims.

    Premisecitation

    Adults with ADHD reported having trouble with others, behavior problems at work, being fired or dismissed from a job, quitting a job out of boredom, and being disciplined by their supervisor on the job in a higher percentage of the jobs they had held than did participants in both the clinical and the community control groups.

    “Adults with ADHD reported having trouble with others, behavior problems at work, being fired or dismissed from a job, quitting a job out of boredom, and being disciplined by their supervisor on the job in a higher percentage of the jobs they had held than did participants in both the clinical and the community control groups.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Barkley et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior work found just the ADHD group to differ from the community group on the Stroop test.

    “We previously reported the group comparisons on this test (Barkley et al., 2008) where we found just the ADHD group to differ from the community group.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barkley et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The eventual set of 88 items was found to form five dimensions of executive dysfunctions using factor analysis: Self-Management to Time (23 items), Self-Organization and Problem-Solving (21 items), Self-Discipline (inhibition-23 items), Self-Motivation (11 items), and Self-Activation and Concentration (10 items).

    “The eventual set of 88 items was found to form five-dimensions of executive dysfunctions using factor analysis: Self-Management to Time (23 items), Self-Organization and Problem-Solving (21 items), Self-Discipline (inhibition-23 items), Self-Motivation (11 items), and Self-Activation and Concentration (10 items).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barkley & Murphy, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    More members of both the ADHD and clinical control groups had problems getting along with others at work (30%, 18%, and 7%, respectively) and had difficulties with their behavior or work performance on the job (53%, 50%, and 5%, respectively).

    “More members of both the ADHD and clinical control groups had problems getting along with others at work (30%, 18%, and 7%, respectively) and had difficulties with their behavior or work performance on the job (53%, 50%, and 5%, respectively).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barkley et al., 2008

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Those measures were collected at the adult follow-up of children with ADHD followed to adulthood and the study found very similar results to those discussed earlier-that being little or no relationship between EF ratings and those EF tests (Barkley & Fischer, 2010).

    “Those measures were collected at the adult follow-up of children with ADHD followed to adulthood and the study found very similar results to those discussed earlier-that being little or no relationship between EF ratings and those EF tests (Barkley & Fischer, 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Barkley & Fischer, 2010

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationnone given

    Such measures can be highly intrusive into the occupations of research participants and cannot be undertaken easily or lightly in conducting research with psychiatric patients.

    “But such measures can be highly intrusive into the occupations of research participants and cannot be undertaken easily or lightly in conducting research with psychiatric patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductnone given

    It is possible that had other items of EF been generated besides the 91 we tested, additional dimensions of EF deficits might have been unearthed.

    “It is possible that had other items of EF been generated besides the 91 we tested additional dimensions of EF deficits might have been unearthed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Although neither method alone should serve as the gold standard for determining the presence of EF deficits, EF ratings may be taken to have greater validity at predicting impairment in daily life activities, and particularly occupational adjustment.

    “Thus, although neither method alone should serve as the gold standard for determining the presence of EF deficits, EF ratings may be taken to have greater validity at predicting impairment in daily life activities, and particularly occupational adjustment.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Earlier findings (Barkley & Murphy, 2009) suggest that no matter what narrowband subscales of particular EF deficit studies may identify, such dimensions are highly inter-correlated and imply the possibility that there is a single over-arching meta-construct of EF shared across all these dimensions.

    “Earlier findings (Barkley & Murphy, 2009) also suggest that no matter what narrowband subscales of particular EF deficit studies may identify, such dimensions are highly inter-correlated and imply the possibility that there is a single over-arching meta-construct of EF shared across all these dimensions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Barkley & Murphy, 2009

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Our employer rating scale can only be considered a relatively crude index of actual workplace problems that might have been revealed by more thorough or detailed workplace measures or direct observations of working.

    “Our employer rating scale can only be considered a relatively crude index of actual workplace problems that might have been revealed by more thorough or detailed workplace measures or direct observations of working.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Our study is limited by the method used to create the EF scale.

    “First, our study is limited by the method used to create the EF scale.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Had other tests of these constructs been used or had additional constructs, such as planning and problem-solving, been assessed, some differences in these results might have been evident.

    “Had other tests of these constructs been used or had additional constructs, such as planning and problem-solving, been assessed, some differences in these results might have been evident.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Such a heterogeneous grouping would not be expected to resemble the distributions of these measures in a general population sample of adults, and the greater range of scores and over-representation of extreme (clinical) cases may have inflated the size of the relationships obtained.

    “Such a heterogeneous grouping would not be expected to resemble the distributions of these measures in a general population sample of adults, and the greater range of scores and over-representation of extreme (clinical) cases may have inflated the size of the relationships obtained.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A second limitation was the relatively circumscribed battery of EF tests used here to assess the various constructs believed to characterize EF.

    “A second limitation was the relatively circumscribed battery of EF tests used here to assess the various constructs believed to characterize EF.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    This does not completely eliminate the problems with the historical nature of the self-reported information.

    “This does not completely eliminate the problems with the historical nature of the self-reported information.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    A further limitation may have occurred in the procedure of collapsing the ADHD and clinical control groups in with the community group to study the relationships among the EF measures and impairment measures.

    “A further limitation may have occurred in the procedure of collapsing the ADHD and clinical control groups in with the community group to study the relationships among the EF measures and impairment measures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We also did not measure other problems in the workplace, such as actual productivity, use of sick leave, and workplace accidents.

    “We also did not measure other problems in the workplace, such as actual productivity, use of sick leave, and workplace accidents that have been found to be associated with ADHD in adults in earlier studies (de Graaf et al., 2008).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    We tried to overcome this by also obtaining the reports of employers about current workplace problems and performance but could only get consent to do so for a subset of participants.

    “We tried to overcome this by also obtaining the reports of employers about current workplace problems and performance but could only get consent to do so for a subset of participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    These findings may not be readily extrapolated to the general population or even to other clinical disorders not represented in the clinical samples used here.

    “Even so, we concede that these findings may not be readily extrapolated to the general population or even to other clinical disorders not represented in the clinical samples used here.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Our EF scale was more comprehensive, theory-based, and empirically constructed than the brief 20-item EF scale created in the study by Burgess and colleagues (1998).

    “It was certainly more comprehensive, theory-based, and empirically constructed than the brief 20-item EF scale created in the study by Burgess and colleagues (1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Burgess and colleagues (1998)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    This would be expected to do as much for the EF tests as for the EF ratings and so would not necessarily account for the differences we found between those measures in their predictive utility of impairments.

    “This would be expected to do as much for the EF tests as for the EF ratings and so would not necessarily account for the differences we found between those measures in their predictive utility of impairments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other problems in the workplace, such as actual productivity, use of sick leave, and workplace accidents, have been found to be associated with ADHD in adults in earlier studies (de Graaf et al., 2008).

    “We also did not measure other problems in the workplace, such as actual productivity, use of sick leave, and workplace accidents that have been found to be associated with ADHD in adults in earlier studies (de Graaf et al., 2008).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites de Graaf et al., 2008 source
62 of 62

  • The paper relies on this without support.

    No research to date has examined the degree to which EF deficits associated with ADHD in adults contribute to their occupational problems.

    “Yet, no research to date to our knowledge has examined the degree to which the EF deficits associated with ADHD in adults might contribute to their occupational problems.”

  • The paper relies on this without support.

    Clinical diagnosis of ADHD without corroboration from others is sufficiently valid for group assignment.

    “Typically, we require corroboration of ADHD symptoms and impairment from someone else who knows the person well, such as parents, siblings, or spouses/partners, as part of making a clinical diagnosis of ADHD.We did not do so here though we did collect such information for most participants.”

  • The paper relies on this without support.

    EF is organized in a hierarchy of levels, with higher levels involving additional abilities and skills not represented in lower levels, and these higher levels contribute to mastering and effectively performing executively at that and higher levels of EF.

    “At each new level of this hierarchy additional abilities and skills come into play that are not represented in lower levels and yet contribute to mastering and effectively performing executively at that and higher levels of EF.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Neuropsychological tests have not been shown to reliably predict functional impairment in adult ADHD, while clinical ratings such as the BRIEF have been successful in this regard.

    “neuropsychological tests have not been shown to reliably predict functional impairment in adult ADHD, while clinical ratings such as the BRIEF have been successful in this regard [25], [26].”

    From Atomoxetine Effects on Executive Function as Measured by the BRIEF-A in Young Adults with ADHD: A Randomized, Double-Blind, Placebo-Controlled Study (2014) · cites this paper as [25]

    The Results and Discussion (page unavailable in our copy) find that executive-function ratings predicted occupational impairment substantially better than executive-function tests in the adults studied. But the study used the Deficits in EF Scale, not the BRIEF, and several tests did predict some occupational outcomes, albeit more weakly; it therefore does not establish the claim for the BRIEF or show that tests never predict impairment. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Prior head-to-head studies have generally found that executive function rating scales predict functional outcomes better than performance-based tests.

    “the few studies that have pitted these two measurement methods head-to-head have generally found that executive function rating scales predict functional outcomes better than performance-based tests (Barkley & Murphy, 2010; Toplak, 2008)”

    From Executive functioning rating scales: Ecologically valid or construct invalid? (2020) · cites this paper as Barkley & Murphy, 2010

  • The study's finding of superior predictive validity for EF performance tests over ratings appears inconsistent with several studies finding that EF ratings predicted functional outcomes better.

    “In contrast, the current study’s findings of superior predictive validity for executive function performance tests vs. ratings appears inconsistent with several studies finding that executive function ratings predicted functional outcomes better than executive function performance tests (Barkley & Murphy, 2010; Gioia et al., 2000; Gross et al., 2015; Kamradt et al., 2014; Mahone & Hoffman, 2007;”

    From Executive functioning rating scales: Ecologically valid or construct invalid? (2020) · cites this paper as Barkley & Murphy, 2010

  • Neuropsychological tests of executive function were not very predictive of occupational impairment in people with ADHD, while EF questionnaires were strongly predictive of occupational impairment.

    “Barkley and Murphy (2010) [68] proved that neuropsychological tests of EF were not very predictive of the occupational impairment experienced every day by people with ADHD, as they showed weak relationships with measures of occupational impairment, while EF-questionnaires were strongly predictive of the occupational-impairment measures mentioned above”

    From Comparing Executive Functions in Children and Adolescents with Autism and ADHD—A Systematic Review and Meta-Analysis (2024) · cites this paper as [68]

  • Self-reported executive function is associated with important functional outcomes measured by self-report and independent measures, including criminal activity, occupational impairment, academic procrastination and psychopathology.

    “self-reported EF is associated with important functional outcomes as measured by both self-report and independent measures (e.g., driving records of DUI citations, informant reports), including criminal activity (Barkley and Murphy 2011), occupational impairment (Barkley and Murphy 2010), academic procrastination (Rabin et al. 2011), and psychopathology (Knouse et al. 2013).”

    From Executive Function Deficits in Daily Life Prospectively Predict Increases in Depressive Symptoms (2014) · cites this paper as Barkley and Murphy 2010

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Employer work-performance contribution is called nonsignificant despite Table 3

    Major

    The discussion says neither approach made a significant contribution to employer-rated work performance. Table 3 reports a significant DEFS contribution when entered first (p = .001).

  • The outcome identified as related to IQ changes

    Minor

    The discussion identifies trouble with one's own behavior or work performance as the only occupational outcome related to IQ. The results instead identify jobs quit because of hostility toward an employer.

  • Incorrect R2 for the first outcome in Table 3

    Minor

    For the EF-tests step predicting the number of jobs held, the reported R of .406 implies an R2 of about .165, not .087. The next row also reports .165 for the same final model.

    Reported 0.087 · recomputed 0.164836

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. 2004, 18, 495
  2. 1982, Perceptual and motor skills, 123, 17

Cited by

Sorted by citations

Related

Authors
Barkley, R. A., & Murphy, K. R.
Affiliations
Medical University of South Carolina (US)
Corresponding author
Barkley, R. A.
ORCID
Murphy, K. R.
Venue
Archives of Clinical Neuropsychology
Publisher
Oxford University Press (OUP)
Published
2010-03-02
Volume
25
Issue
3
Pages
157-173
ISSN
  • 0887-6177 (ISSN-L)
  • 1873-5843
DOI
10.1093/arclin/acq014
PMC
PMC2858600
OpenAlex
W2117169541
Cited by
468
References
57
Citations by year
2026: 30 · 2025: 26 · 2024: 30 · 2023: 30 · 2022: 28 · 2021: 35 · 2020: 31 · 2019: 29 · 2018: 28 · 2017: 26 · 2016: 27 · 2015: 26 · 2014: 36 · 2013: 29 · 2012: 28
FWCI
18.75
Type
journal article
Language
en
Open access
Locations
  • Archives of Clinical Neuropsychology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Shire
  • National Institute of Mental Health (MH54509, R01MH054509)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
  • Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
Keywords
adult ADHD, executive function, occupational functioning, workplace adaptation
MeSH terms
Adult, Attention Deficit Disorder with Hyperactivity, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Occupations, Problem Solving, Quality of Life, Surveys and Questionnaires, Regression Analysis, Social Adjustment, Work, Executive Function

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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