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

The DOI matches its Crossref record; 57 of the 57 references it cites were found in a registry or an index; 7 of the 59 sources its claims cite were checked for support.

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

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.

Overview

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

57 of 57 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

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

Show all 59 claims

  • It may state two separate claims as one. 42
  • Probably not a substantial claim. 31
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?

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

Citations

Cites

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Show all 57 references

Research works printed but not linked: 2

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

Cited by

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Metadata

Authors
Barkley, R. A., & Murphy, K. R.
Affiliations
Medical University of South Carolina (US)
Corresponding author
Barkley, R. A.
Venue
Archives of Clinical Neuropsychology
Published
2010-03-02
Volume
25
Issue
3
Pages
157-173
ISSN
  • 0887-6177 (ISSN-L)
  • 1873-5843
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

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