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

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 activities generally and occupational functioning specifically at adult follow-up than are EF tests. We hypothesize that this paradox arises from each method assessing different levels of a hierarchically organized EF meta-construct briefly discussed herein.