The Nature of Executive Function (EF) Deficits in Daily Life Activities in Adults with ADHD and Their Relationship to Performance on EF Tests

Abstract

Although attention-deficit/hyperactivity disorder (ADHD) is believed to impair EF, research using EF tests shows such deficits exist in only a minority of those with ADHD. This study hypothesized that this disparity is largely due to the low ecological validity of these EF tests. A 91-item rating scale of EF was constructed based on EF theories and found to represent 5 underlying dimensions: Self-Management to Time, Self-Organization/Problem-Solving, Self-Discipline, Self-Motivation, and Self-Activation/Concentration. Three groups were compared on these scales: Adults with ADHD (N = 146), Clinical control adults not diagnosed with ADHD (N = 97), and a Community control group (N = 109). The ADHD group had more severe EF ratings than did the Clinical group and Community control groups on all 5 scales using both self and other-reported versions. Relationships between the EF scales and tests were low and mostly not significant. Most ADHD adults were clinically impaired on the EF ratings but only a small minority were so on the tests. The EF ratings were more highly associated with measures of deviant behavior (antisocial acts, crime diversity, negative driving outcomes) than the EF tests, most of which were unrelated to such behavior. These results agree with previous research showing that EF tests are largely unrelated to EF ratings and that EF ratings are more strongly associated with impairment in major life activities, in this case deviant or antisocial behavior. Contrary to earlier conclusions based on EF tests, adult ADHD involves substantial problems in EF in daily life.