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Executive functions and adaptive functioning in young adult attention-deficit/hyperactivity disorder

Published online by Cambridge University Press:  02 February 2007

GILLIAN M. STAVRO ,
MARK L. ETTENHOFER  and
JOEL T. NIGG
GILLIAN M. STAVRO
Affiliation:
Department of Psychology, Michigan State University, East Lansing, Michigan
MARK L. ETTENHOFER
Affiliation:
Department of Psychology, Michigan State University, East Lansing, Michigan
JOEL T. NIGG
Affiliation:
Department of Psychology, Michigan State University, East Lansing, Michigan
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Abstract

Attention-deficit/hyperactivity disorder (ADHD) is associated with impairments in occupational, social, and educational functioning in adults. This study examined relations of adaptive impairment to ADHD symptom domains (inattentive–disorganized and hyperactive–impulsive) and to deficits in executive functioning (EF) in 195 well-characterized adults (105 ADHD, 90 non-ADHD, between ages 18 and 37). Participants completed a battery of EF measures as well as assessments of adaptive functioning. Confirmatory factor analyses were used to validate latent factors for adaptive functioning and EF. In a measurement model, weaker EF was associated with poorer adaptive functioning (r = −.30). When multi-informant composite variables for current inattentive–disorganized and hyperactive–impulsive ADHD symptoms were included in the structural model, EF no longer predicted adaptive functioning. While both symptom composites were similarly related to EF (inattentive–disorganized r = .36; hyperactive–impulsive r = .29), inattentive–disorganized symptoms accounted for more variance in adaptive functioning (67.2% vs. 3.6%). Furthermore, for retrospectively reported childhood symptoms of ADHD, only the inattentive–disorganized symptom domain was related to EF or adaptive impairment. These results suggest that, in adults with ADHD, inattentive–disorganized symptoms may be the primary contributor to key aspects of poorer adaptive function and may be the behavioral path through which EF deficits lead to adaptive impairment. (JINS, 2007, 13, 324–334.)

Keywords

Attention-deficit disorder with hyperactivityCognition disordersBehavioral symptomsNeuropsychological testsAchievementEmployment

Information

Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 13 , Issue 2 , March 2007 , pp. 324 - 334
Copyright
© 2007 The International Neuropsychological Society

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References

REFERENCES

Achenbach, T.M. (1997). Manual for the Young Adult Self-Report and Young Adult Behavior Checklist. Burlington, VT: University of Vermont, Department of Psychiatry.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association Press.
AMOS for Windows. Rel. 5.0, Build 5138. (2003). Chicago: SmallWaters Corp.
Barkley, R.A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65–94.Google Scholar
Barkley, R.A. (2002). Major life activity and health outcomes associated with attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 63, 10–15.Google Scholar
Barkley, R.A., Fischer, M., Edelbrock, C.S., & Smallish, L. (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 29, 546–557.Google Scholar
Barkley, R.A. & Murphy, K. (1998). Attention-deficit hyperactivity disorder: A clinical workbook (2nd ed.). New York: The Guilford Press.
Barkley, R.A., Murphy, K., & Kwasnik, D. (1996). Psychological adjustment and adaptive impairments in young adults with ADHD. Journal of Attention Disorders, 1, 41–54.Google Scholar
Barkley, R.A., Murphy, K.R., DuPaul, G.J., & Bush, T. (2002). Driving in young adults with attention deficit hyperactivity disorder: Knowledge, performance, adverse outcomes, and the role of executive functioning. Journal of the International Neuropsychological Society, 8, 655–672.Google Scholar
Bentler, P.M. (1990). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 107, 238–246.Google Scholar
Biederman, J., Faraone, S.V., Keenan, K., Benjamin, J., Krifcher, B., Moore, C., Sprich-Buckminster, S., Ugaglia, K., Jellinek, M.S., Steingard, R., Spencer, T., Norman, D., Kolodny, R., Kraus, I., Perrin, J., Keller, M.B., & Tsuang, M.T. (1992). Further evidence for family-genetic risk factors in attention deficit hyperactivity disorder. Patterns of comorbidity in probands and relatives in psychiatrically and pediatrically referred samples. Archives of General Psychiatry, 49, 728–738.Google Scholar
Biederman, J., Faraone, S.V., Keenan, K., Knee, D., & Tsuang, M.T. (1990). Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 526–533.Google Scholar
Biederman, J., Faraone, S., Milberger, S., Guite, J., Mick, E., Chen, L., Mennin, D., Marrs, A., Ouellette, C., Moore, P., Spencer, T., Norman, D., Wilens, T., Kraus, I., & Perrin, J. (1996). A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Archives of General Psychiatry, 53, 437–446.Google Scholar
Biederman, J., Faraone, S.V., Spencer, T., Wilens, T., Norman, D., Lapey, K., Mick, E., Lehman, B.K., & Doyle, A. (1993). Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry, 150, 1792–1798.Google Scholar
Biederman, J., Monuteaux, M.C., Doyle, A.E., Seidman, L.J., Wilens, T., Ferrero, F., Morgan, C.L., & Faraone, S.V. (2004). Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. Journal of Consulting and Clinical Psychology, 72, 757–766.Google Scholar
Bilder, R.M., Goldman, R.S., Robinson, D., Reiter, G., Bell, L., Bates, J.A., Pappadopulos, E., Willson, D.F., Alvir, J.M.J., Woerner, M.G., Geisler, S., Kane, J.M., & Lieberman, J.A. (2000). Neuropsychology of first-episode schizophrenia: Initial characterization and clinical correlates. American Journal of Psychiatry, 157, 549–559.Google Scholar
Brown, T.E. (1996). Brown Attention-Deficit Disorder Scales. San Antonio, TX: The Psychological Corporation.
Burgess, P.W., Alderman, N., Evans, J., Emslie, H., & Wilson, B.A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society, 4, 547–558.Google Scholar
Conners, C.K., Erhardt, D., & Sparrow, E. (1999). Adult ADHD Rating Scales: Technical manual. Toronto: Multi-Health Systems, Inc.
Crépeau, F. & Scherzer, P. (1993). Predictors and indicators of work status after traumatic brain injury: A meta-analysis. Neuropsychological Rehabilitation, 3, 5–35.Google Scholar
Crowe, S.F. (1998). The differential contribution of mental tracking, cognitive flexibility, visual search, and motor speed to performance on parts A and B of the Trail Making Test. Journal of Clinical Psychology, 54, 585–591.Google Scholar
Davis, H.P. & Keller, F. (2002). Colorado Assessment Tests (CATS, Version 1.2). Colorado Springs, CO: Author.
Delis, D.C., Kaplan, E., & Kramer, J.H. (2001). Delis-Kaplan Executive Function System Manual. San Antonio, TX: Harcourt Assessment, Inc.
Denckla, M.B. (1996). A theory and model of executive function: A neuropsychological perspective. In G.R. Lyon & N.A. Krasnegor (Eds.), Attention, memory, and executive function. Baltimore, MD: Brookes Publishing.
Duncan, J., Johnson, R., Swales, M., & Freer, C. (1997). Frontal lobe deficits after head injury: Unity and diversity of function. Cognitive Neuropsychology, 14, 713–741.Google Scholar
Eslinger, P.J. & Damasio, A.R. (1985). Severe disturbance of higher cognitive function after bilateral frontal ablation: Patient EVR. Neurology, 35, 1731–1741.Google Scholar
Faraone, S.V. (2000). Attention deficit hyperactivity disorder in adults: Implications for theories of diagnosis. Current Directions in Psychological Science, 9, 33–36.Google Scholar
First, M., Spitzer, R., Gibbon, M., & Williams, J. (1997). Structured clinical interview for DSM-IV Axis I disorders. Washington, DC: American Psychiatric Press.
Golden, C.J. (1978). Stroop Color and Word Test. Wood Dale, IL: Stoelting Co.
Hanes, K.R., Andrewes, D.G., Smith, D.J., & Pantelis, C. (1996). A brief assessment of executive control dysfunction: Discriminant validity and homogeneity of planning, set shift, and fluency measures. Archives of Clinical Neuropsychology, 11, 185–191.Google Scholar
Hart, E.L., Lahey, B.B., Loeber, R., Applegate, B., Green, S.M., & Frick, P.J. (1995). Developmental change in attention-deficit hyperactivity disorder in boys: A four-year longitudinal study. Journal of Abnormal Child Psychology, 23, 729–749.Google Scholar
Heaton, R.K., Chelune, G.J., Talley, J.L., Kay, G.G., & Curtiss, G. (1993). Wisconsin Card Sorting Test Manual. Lutz, FL: Psychological Assessment Resources.
Hervey, A.S., Epstein, J.N., & Curry, J.F. (2004). Neuropsychology of adults with attention-deficit/hyperactivity disorder: A meta-analytic review. Neuropsychology, 18, 485–503.Google Scholar
Hinshaw, S.R. (2002). Is ADHD an impairing condition in childhood and adolescence? In P.S. Jensen & J.R. Cooper (Eds.), Attention deficit hyperactivity disorder: State of the science-best practices. Kingston, NJ: Civic Research Institute.
Holdnack, J.A., Moberg, P.J., Arnold, S.E., Gur, R.C., & Gur, R.E.. (1995). Speed of processing and verbal learning deficits in adults diagnosed with attention deficit disorder. Neuropsychiatry, Neuropsychology, & Behavioral Neurology, 8, 282–292.Google Scholar
Joreskog, K.G. & Sorbom, D. (1981). Analysis of linear structural relationships by maximum likelihood and least squares methods (Research Report No. 81-8). Uppsala, Sweden: University of Uppsala.
Kline, R.B. (2004). Principles and practice of structural equation modeling (Vol. 2). New York: The Guilford Press.
Kongs, S.K., Thompson, L.L., Iverson, G.L., & Heaton, R.K. (2000). Wisconsin Card Sorting Test—64 Card Computerized Version. Odessa, FL: Psychological Assessment Resources.
LeBlanc, J.M., Hayden, M.E., & Paulman, R.G. (2000). A comparison of neuropsychological and situational assessment for predicting employability after closed head injury. Journal of Head Trauma Rehabilitation, 15, 1022–1040.Google Scholar
Lezak, M.D., Howieson, D.B., Loring, D.W., Hannay, H.J., & Fischer, J.S. (2004). Neuropsychological assessment (4th ed.). New York: Oxford University Press.
Logan, G.D., Schachar, R.J., & Tannock, R. (1997). Impulsivity and inhibitory control. Psychological Science, 8, 60–64.Google Scholar
Lowe, C. & Rabbitt, P. (1998). Test/re-test reliability of the CANTAB and ISPOCD neuropsychological batteries: Theoretical and practical issues. Neuropsychologia, 36, 915–923.Google Scholar
Luborsky, L. (1962). Clinicians' judgments of mental health: A proposed scale. Archives of General Psychiatry, 7, 407–417.Google Scholar
Miller, T.W. & Nigg, J.T. (Under review). Axis I and Axis II comorbidity in adults with ADHD.
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., & Howerter, A. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41, 49–100.Google Scholar
Moriyama, Y., Mimura, M., & Kato, M. (2002). Executive dysfunction and clinical outcome in chronic alcoholics. Alcoholism: Clinical and Experimental Research, 26, 1239–1244.Google Scholar
Murphy, K. & Barkley, R.A. (1996). Attention deficit hyperactivity disorder adults: Comorbidities and adaptive impairments. Comprehensive Psychiatry, 37, 393–401.Google Scholar
Murphy, K., Barkley, R.A., & Bush, T. (2001). Executive functioning and olfactory identification in young adults with attention deficit-hyperactivity disorder. Neuropsychology, 15, 211–220.Google Scholar
Nigg, J.T., Stavro, G., Ettenhofer, M., Hambrick, D.Z., Miller, T., & Henderson, J.M. (2005). Executive Functions and ADHD in Adults: Evidence for Selective Effects on ADHD Symptom Domains. Journal of Abnormal Psychology Toward a Dimensionally Based Taxonomy of Psychopathology, 114, 706–717.Google Scholar
Pennington, B.F. & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry Annual Research Review, 37, 51–87.Google Scholar
Puig-Antich, J. & Ryan, N. (1986). Schedule for affective disorders and schizophrenia for school-age children. Pittsburgh, PA: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine.
Rabbitt, P. (1997). Methodology and models in the study of executive functions. In P. Rabbitt (Ed.), Methodology of frontal and executive function (pp. 1–38). East Sussex, UK: Psychology Press.
Reitan, R.M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271–276.Google Scholar
Riccio, C.A., Wolfe, M., Davis, B., Romine, C., George, C., & Lee, D. (2005). Attention deficit hyperactivity disorder: Manifestation in adulthood. Archives of Clinical Neuropsychology, 20, 249–269.Google Scholar
Riccio, C.A., Wolfe, M.E., Romine, C., Davis, B., & Sullican, J.R. (2004). The Tower of London and neuropsychological assessment of ADHD in adults. Archives of Clinical Neuropsychology, 19, 661–671.Google Scholar
Sattler, J.M. (2001). Assessment of children: Cognitive applications, 4th ed. San Diego, CA: Jerome M. Sattler, Publisher, Inc.
Sohlberg, M.M. & Mateer, C.A. (2001). Cognitive rehabilitation: An integrative neuropsychological approach. New York: Guilford Press.
Sonuga-Barke, E.J.S. (2002). Psychological heterogeneity in AD/HD—A dual pathway model of behaviour and cognition. Behavioural Brain Research Special Issue: Neurobehavioural Mechanisms in ADHD, 130, 29–36.Google Scholar
Sonuga-Barke, E.J.S. (2005). Causal models of attention-deficit/hyperactivity disorder: From common simple deficits to multiple developmental pathways. Biological Psychiatry, 57, 1231–1238.Google Scholar
Steiger, J.H. (1990). Structural model evaluation and modification: An interval estimation approach. Multivariate Behavioral Research, 25, 173–180.Google Scholar
Stuss, D.T., Levine, B., Alexander, M.P., Hong, J., Palumbo, C., Hamer, L., & Murphy, K. (2000). Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: Effects of lesion location and test structure on separable cognitive processes. Neuropsychologia, 38, 388–402.Google Scholar
Walker, A.J., Shores, E.A., Tollor, J.N., Lee, T., & Sachdev, P.S. (2000). Neuropsychological functioning of adults with attention deficit hyperactivity disorder. Journal of Clinical and Experimental Neuropsychology, 22, 115–124.Google Scholar
Wasserstein, J. & Lynn, A.E. (2001). Metacognitive remediation in adult ADHD: Treating executive function deficits via executive functions. In J. Wasserstein, L.E. Wolf, & F.F. LeFever (Eds.), Adult attention deficit disorder: Brain mechanisms and life outcomes. New York: New York Academy of Sciences.
Wechsler, D. (1997). Wechsler Adult Intelligence Scale—Third Edition. New York: Psychological Corporation.
Weiss, M. & Murray, C. (2003). Assessment and management of attention-deficit hyperactivity disorder in adults. Canadian Medical Association Journal, 168, 715–722.Google Scholar
Welsh, M.C. & Pennington, B.F. (1988). Assessing frontal lobe functioning in children: Views from developmental psychology. Developmental Neuropsychology, 4, 199–230.Google Scholar
Wender, P.H., Wolf, L.E., & Wasserstein, J. (2001). Adults with ADHD: An overview. In J. Wasserstein, L.E. Wolf, & F.F. LeFever (Eds.), Adult attention deficit disorder: Brain mechanisms and life outcomes. New York: New York Academy of Sciences.
Weyandt, L.L., Rice, J.A., Linterman, I., Mitzlaff, L., & Emert, E. (1998). Neuropsychological performance of a sample of adults with ADHD, developmental disorder, and controls. Developmental Neuropsychology, 14, 643–656.Google Scholar
Wilcox, R.R., Keselman, H.J., & Kowalchuk, R.K. (1998). Can tests for treatment group equality be improved?: The bootstrap and trimmed means conjecture. British Journal of Mathematical and Statistical Psychology, 51, 123–134.Google Scholar