Discordance Between Psychometric Testing and Questionnaire-Based Definitions of Executive Function Deficits in Individuals With ADHD

The construct validity of executive function rating scales has been questioned because they consistently correlate non-significantly or weakly with performance-based tests measuring the same construct.

“the construct validity of executive function rating scales has been questioned because they consistently correlate non-significantly (Biederman et al., 2008; Conklin et al., 2008; Mahone et al., 2002) or weakly (Gross et al. 2015; Miranda et al., 2015; Nordvall et al., 2017) with performance-based tests measuring the same construct.”

Replicated evidence shows that executive function rating scales and performance-based tests are weakly or non-significantly associated with each other.

“replicated evidence indicates weak/non-significant cross-method associations that suggest divergent rather than convergent validity.”

The modest EF test/rating association is consistent with prior literature showing modest to non-significant measure-level relations in child, adolescent, and adult populations.

“This finding was highly consistent with prior literature showing modest to non-significant measure-level relations between these two putative methods for assessing the same construct in child, adolescent, and adult populations (Biederman et al., 2008; Conklin et al., 2008; Mahone et al., 2002)”

The concept of "executive dysfunction" is heterogeneous and different behavioral and neurocognitive measures are often only weakly correlated with each other.

“It is important to note in this regard that the concept of “executive dysfunction” is heterogeneous and that different behavioral and neurocognitive measures are often only weakly correlated with each other (Biederman et al., 2008).”

In adults with ADHD, there was little overlap in the impairment identified by performance-based and rating measures of executive function.

“There was little overlap in the impairment identified by these two domains of measures.”

Only 14% of participants who had impairment on performance-based measures of executive function reported impairment on the rating scale measure of executive function.

“Only 14% of the participants who had impairment on the performancebased measures of executive function reported impairment on the rating scale measure of executive function.”

Impairment on performance-based measures of executive function does not translate into impairment on ratings of executive function, or vice versa.

“Impairment on performance-based measures of executive function does not translate into impairment on ratings of executive function, or vice versa , as was demonstrated by Biederman et al. (2008).”

Biederman and colleagues found only a modest overlap between psychometric and self-reported measures of executive function impairment among ADHD patients.

“Biederman and colleagues [27] found only a modest overlap between psychometric and self-reported measures of executive function impairment among ADHD patients.”

Neuropsychological testing was largely found to identify patients with lower IQ and achievement testing, while behavioral questionnaire assessment chiefly identified patients with higher levels of ADHD symptoms, psychiatric comorbidity, and interpersonal deficits.

“Neuropsychological testing was largely found to identify patients with lower IQ and achievement testing, while behavioral questionnaire assessment chiefly identified patients with higher levels of ADHD symptoms, psychiatric comorbidity, and interpersonal deficits.”