Executive functioning in adults with attention deficit hyperactivity disorder: A systematic review
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Keywords

ADHD
Adults
Executive functions
Prefrontal Cortex Neuropsychology
Mental disorder

Abstract

Introduction: Executive function deficits are associated with attention deficit hyperactivity disorder (ADHD) in both children and adults. The inattentive subtype is primary related to “cold” executive functions, while the hyperactive subtype is related to “warm” executive functions.

Objective: To systematically review studies on executive functioning in adults with attention deficit hyperactivity disorder published during the last decade.

Methodology: A documentary research was conducted, encompassing 33 articles retrieved from PubMed, Web of Science and EBSCO platforms. The analysis considered years and countries of publication, attention deficit hyperactivity disorder diagnostic criteria, participants, comorbidities, subtypes, medication use, assessment tools, and processes of executive functions evaluated.

Results: It was evidenced that there is a high percentage of adults with attention deficit hyperactivity disorder  who present a deficit or lower performance in executive function tests. However, the results varied depending on specific characteristics of the study and/or participants, which confirms the heterogeneity of the disorder. In addition, the main instruments for measuring executive functions and diagnostic criteria for adult attention deficit hyperactivity disorder were identified.

Discussion: These results support the established links between attention deficit hyperactivity disorder , impaired executive functions, and major life activities found in the adult attention deficit hyperactivity disorder  literature. However, some of the limitations were the poorly controlled variables such as comorbidities, attention deficit hyperactivity disorder  subtypes that were not assessed, and usage of instruments that measure executive functions that can lead to reduced credibility of the results presented here.

Conclusions: According to the results presented, there is a high percentage of adults with attention deficit hyperactivity disorder who present a deficit or lower performance in executive function tests, compared to both neurotypical adults and those with other psychiatric disorders. Further research is recommended to continue studies on the topic and to include other variables.

https://doi.org/10.22379/anc.v40i3.1208
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References

Vélez Álvarez C, Vidarte Claros JA. Trastorno por déficit de atención e hiperactividad (TDAH), una problemática a abordar en la política pública de primera infancia en Colombia. Rev Salud Pública. 2012 Jun;14:113–28. doi.org/10.1590/S0124-00642012000800010

Hernández M, Pastor N, Pastor X, Boix C, Sans A. Calidad de vida en niños con trastorno por déficit de atención con o sin hiperactividad (TDAH). Rev Pediatr Aten Primaria. 2017;19:31-9.

American Psychiatric Association. Guía de consulta de los criterios diagnósticos del DSM 5. United States: American Psychiatric Publishing; 2013.

Teles A, da Costa S, Holanda MF, Ramos FA, Santos JP dos S. A prevalência do transtorno do déficit de atenção e hiperatividade (tdah): Uma revisão de literatura. PSICOLOGIA. 2015 Dec;29(2):47–62. https://doi.org/10.17575/rpsicol.v29i2.1031

Sánchez CR, Ramos C, Díaz F, López D. Attention-deficit/hyperactivity disorder: prevalence of risk in the scholastic scope of the Canary Islands. Actas Esp Psiquiatr. 2014 Jul;42(4):169–75.

Alloway T, Elliott J, Holmes J. The Prevalence of ADHD-Like Symptoms in a Community Sample. J Atten Disord. 2010 Apr;14(1):52-6. https://doi.org/10.1177/1087054709356197

Ullebø AK, Posserud MB, Heiervang E, Obel C, Gillberg C. Prevalence of the ADHD phenotype in 7- to 9-year-old children: effects of informant, gender and non-participation. Soc Psychiatry Psychiatr Epidemiol. 2012 May;47(5):763-769. https://doi.org/10.1007/s00127-011-0379-3

Soma Y, Nakamura K, Oyama M, Tsuchiya Y, Yamamoto M. Prevalence of attention-deficit/hyperactivity disorder (ADHD) symptoms in preschool children: discrepancy between parent and teacher evaluations. Environ Health Prev Med. 2009 Mar;14(2):150-154. https://doi.org/10.1007/s12199-008-0075-4

Jin W, Du Y, Zhong X, David C. Prevalence and contributing factors to attention deficit hyperactivity disorder: A study of five- to fifteen-year-old children in Zhabei District, Shanghai. Asia-Pacific Psychiatry. 2013 Dec;6(4):397–404. https://doi.org/10.1111/appy.12114

Kashala E, Tylleskar T, Elgen I, Kayembe KT, Sommerfelt K. Attention deficit and hyperactivity disorder among school children in Kinshasa, Democratic Republic of Congo. Afr Health Sci. 2005 Sep;5(3):172-181. https://doi.org/10.5555/afhs.2005.5.3.172

Ndukuba AC, Odinka PC, Muomah RC, Obindo JT, Omigbodun OO. ADHD Among Rural Southeastern Nigerian Primary School Children: Prevalence and Psychosocial Factors. J Atten Disord. 2014 Jul;21(10):865-871. https://doi.org/10.1177/1087054714543367

Polanczyk G, Willcutt E, Salum G, Kieling C, Rohde L. ADHD prevalence estimates across three decades: An updated systematic review and meta-regression analysis. Int J of Epidemiol. 2014 Jan;43, 434-42. https://doi.org/10.1093/ije/dyt261

De la Peña F, Palacio J, Barragán E. Declaración de Cartagena para el Trastorno por Déficit de Atención con Hiperactividad (TDAH): rompiendo el estigma. Rev Cienc Salud. 2010 Apr;8(1):95-100.

Sánchez EY, Velarde S, Britton GB. Estimated Prevalence of Attention-Deficit/Hyperactivity Disorder in a Sample of Panamanian School-Aged Children. Child Psychiatry Hum Dev. 2011 Apr;42(2):243–55. https://doi.org/10.1007/s10578-010-0213-2

Fontana R, Vasconcelos MM, Werner Jr, Góes FV, Liberal EF. Prevalência de TDAH em quatro escolas públicas brasileiras. Arq Neuro-Psiquiatr. 2007 Mar;65:134–7. https://doi.org/10.1590/S0004-282X2007000100027

Cornejo Escatell E, Fajardo Fregoso BF, López Velázquez VM , Soto Vargs J, Ceja Moreno H. Prevalencia de déficit de atención e hiperactividad en escolares de la zona noreste de Jalisco, México. Rev Med MD. 2015 Feb-Apr;6(3):190-195.

Jiménez Figueroa G, Vidarte Claros JA, Restrepo de Mejía F. Control de la interferencia en el trastorno por déficit de atención e hiperactividad (TDAH): revisión*. CES Psico. 2020 Apr;13(1):104-2. https://doi.org/10.21615/cesp.13.1.7

Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br JPsychiatry. 2007 May;190(5):402–9. https://doi.org/10.1192/bjp.bp.106.034389

Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006 Apr;163(4):716–23. https://doi.org/10.1176/appi.ajp.163.4.716

Navarro NM. Caracterización y evolución del TDAH en la atapa adulta. Cuadernos de Psiquiatría comunitaria. 2012 Aug;11(2):87–96.

Barkley RA. Global Issues Related to the Impact of Untreated Attention-Deficit/Hyperactivity Disorder From Childhood to Young Adulthood. Postgrad Med. 2008 Jan;120(3):48–59. https://doi.org/10.3810/pgm.2008.09.1907

Biederman J. Attention-Deficit/Hyperactivity Disorder: A Selective Overview. Biological Psychiatry. 2005 Jun; 57(11):1215–20. https://doi.org/10.1016/j.biopsych.2004.10.020

Franke B, Faraone SV, Asherson P, Buitelaar J, Bau CHD, Ramos Quiroga JA, et al. The genetics of attention deficit/hyperactivity disorder in adults, a review. Mol Psychiatry. 2012 Oct;17(10):960–87. https://doi.org/10.1038/mp.2011.138

Larsson H, Chang Z, D'Onofrio BM, Lichtenstein P. The heritability of clinically diagnosed attention deficit hyperactivity disorder across the lifespan. Psychol Med. 2014 Jul; 44(10):2223–9. https://doi.org/10.1017/S0033291713002493

Banerjee TD, Middleton F, Faraone SV. Environmental risk factors for attention-deficit hyperactivity disorder. Acta Paediatr. 2007 Sep;96(9):1269–74. https://doi.org/10.1111/j.1651-2227.2007.00430.x

Sagiv SK, Epstein JN, Bellinger DC, Korrick SA. Pre- and Postnatal Risk Factors for ADHD in a Nonclinical Pediatric Population. Jo Atten Disord. 2013 Jan;17(1):47–57. https://doi.org/10.1177/1087054711427563

Rivera Flores GW. Etiología del Trastorno por Déficit de Atención e Hiperactividad y Características Asociadas en la Infancia y Niñez. Acta de Investigación Psicol. 2013 Aug;3(2):1079–91. https://doi.org/10.1016/S2007-4719(13)70953-0

Dark C, Homman Ludiye J, Bryson Richardson RJ. The role of ADHD associated genes in neurodevelopment. Dev Biol. 2018 Jun;438(2):69–83. https://doi.org/10.1016/j.ydbio.2018.03.023

Pelayo J, Trabajo P, Zapico Y. Aspectos históricos y evolución del concepto de Trastorno por Déficit de Atención e Hiperactividad (TDAH): mitos y realidades. Cuadernos de Psiquiatría comunitaria. 2012;11(2):7–20.

Casas A, Colomer D, Fernández A, Roselló M. Estudio longitudinal de la evolución del TDAH y problemas asociados en la vida adulta. International Journal of Developmental and Educational Psychology. 2013;1(1):643-652.

Wilens TE, Dodson W. A Clinical Perspective of Attention-Deficit/Hyperactivity Disorder Into Adulthood. J Clin Psychiatry. 2004 Oct;65(10):1301–13. https://doi.org/10.4088/JCP.v65n1003

Goodman W. The Consequences of Attention-Deficit/Hyperactivity Disorder in Adults. J Psychiatr Pract. 2007 Sep;13(5):318–27. https://doi.org/10.1097/01.pra.0000290670.87236.18

Faraone SV, Biederman J, Spencer T, Wilens T, Seidman LJ, Mick E, et al. Attention-deficit/hyperactivity disorder in adults: an overview. Biol Psychiatry. 2000 Jul;48(1):9–20. https://doi.org/10.1016/S0006-3223(00)00889-1

Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol and Psychiatry. 2004 Feb;45(2):195–211. https://doi.org/10.1111/j.1469-7610.2004.00214.x

Ramos Quiroga JA, Bosch R, Castells Cervelló X, Nogueira M, García Giménez E, Casas M. Trastorno por déficit de atención con hiperactividad en adultos: caracterización clínica y terapéutica. Rev Neurol. 2006;42(10):600-606. https://doi.org/10.33588/rn.4210.2005495

Gordon CT, Fabiano GA. The Transition of Youth with ADHD into the Workforce: Review and Future Directions. Clin Child and Fam Psychol Rev. 2019 Seb;22(3):316–47. https://doi.org/10.1007/s10567-019-00274-4

Roselló B, Berenguer C, Baixauli I. La inhibición, el autocontrol emocional, la memoria de trabajo y la supervisión ¿predicen las manifestaciones típicas de adultos con TDAH?. Revista INFAD de Psicología. 2019 Jul;2(1):181-92. https://doi.org/10.17060/ijodaep.2019.n1.v2.1428

Hervas A, Durán O. El TDAH y su comorbilidad. Pediatr Integral. 2014;18(9):643-54.

Biederman J, Faraone SV. Attention-deficit hyperactivity disorder. The Lancet. 2005 Jul;366(9481):237–48. https://doi.org/10.1016/S0140-6736(05)66915-2

Valdizán JR, Izaguerri Gracia AC. Trastorno por déficit de atención/hiperactividad en adultos. Rev Neurol. 2009;48 (Supl. 2):S95-S99. https://doi.org/10.33588/rn.48S02.2009017

Verdejo García A, Bechara A. Neuropsicología de las funciones ejecutivas. Psicothema. 2010;22(2):227-235.

García M. Las funciones ejecutivas cálidas y el rendimiento académico [doctoral thesis]. Madrid: E-Prints Complutense; 2012. Available from: https://bit.ly/32k4c3W

Woods SP, Lovejoy DW, Ball JD. Neuropsychological Characteristics of Adults with ADHD: A Comprehensive Review of Initial Studies. Clin Neuropsychol. 2002 Feb;16(1):12–34. https://doi.org/10.1076/clin.16.1.12.8336

Slachevsky A, Pérez C, Silva J, Ruiz-Tagle A, Mayol R, Muñoz-Neira C, et al. Prognostic heterogeneity of attention deficit/hyperactivity disorder in adults. Rev. méd. Chile. 2012 Mar;140(3):379-385. https://doi.org/10.4067/S0034-98872012000300016

Jonsdottir S, Bouma A, Sergeant J, Scherder E. Relationships between neuropsychological measures of executive function and behavioral measures of ADHD symptoms and comorbid behavior. Arch Clin Neuropsychol. 2006 Aug;21(5):383–94. https://doi.org/10.1016/j.acn.2006.05.003

Beltrán, O. Revisiones sistemáticas de la literatura. Rev Col Gastroenterol. 2005 Mar;20(1):60-69.

García J, Domínguez J. ¿Existe un sobrediagnóstico del trastorno de déficit de atención e hiperactividad (TDAH)?. Evid Pediatr. 2012 Aug; 8:51.

Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull. 1997;121(1):65-94. https://doi.org/10.1037/0033-2909.121.1.65

Cheung AM, Mitsis EM, Halperin JM. The Relationship of Behavioral Inhibition to Executive Functions in Young Adults. J Clin Exp Neuropsychol. 2004 May;26(3):393–404. https://doi.org/10.1080/13803390490510103

Biederman J, Petty C, Fried R, Fontanella J, Doyle AE, Seidman LJ, et al. Impact of Psychometrically Defined Deficits of Executive Functioning in Adults With Attention Deficit Hyperactivity Disorder. Am J Psychiatry. 2006 Oct;163(10):1730–8. https://doi.org/10.1176/ajp.2006.163.10.1730

Pritchard AE, Nigro CA, Jacobson LA, Mahone EM. The Role of Neuropsychological Assessment in the Functional Outcomes of Children with ADHD. Neuropsychol Rev. 2011 Nov;22(1):54–68. https://doi.org/10.1007/s11065-011-9185-7

Godard J, Grondin S, Baruch P, Lafleur MF. Psychosocial and neurocognitive profiles in depressed patients with major depressive disorder and bipolar disorder. Psychiatry Res. 2011 Dec;190(2-3):244–52. https://doi.org/10.1016/j.psychres.2011.06.014

Gualtieri CT, Morgan DW. The Frequency of Cognitive Impairment in Patients With Anxiety, Depression, and Bipolar Disorder: An Unaccounted Source of Variance in Clinical Trials. J Clin Psychiatry. 2008 Jul;69(7):7441. https://doi.org/10.4088/JCP.v69n0712

Bannon S, Gonsalvez CJ, Croft RJ, Boyce PM. Executive functions in obsessive-compulsive disorder: state or trait deficits?. Aust N Z J Psychiatry. 2006;40(11-12):1031-1038. https://doi.org/10.1080/j.1440-1614.2006.01928.x

Holst Y, Thorell LB. Neuropsychological Functioning in Adults With ADHD and Adults With Other Psychiatric Disorders: The Issue of Specificity. J Atten Disord. 2017 Oct;21(2):137-148. https://doi.org/10.1177/1087054713506264

Anselm B, Fuermaier ABM, Tucha L, Koerts J, Weisbrod M, Lange KW, et al. Effects of methylphenidate on memory functions of adults with ADHD. Appl Neuropsychol: Adult. 2017 May;24(3):199–211. https://doi.org/10.1080/23279095.2015.1124108

Ni H-C, Shang C-Y, Gau SS-F, Lin Y-J, Huang H-C, Yang L-K. A head-to-head randomized clinical trial of methylphenidate and atomoxetine treatment for executive function in adults with attention-deficit hyperactivity disorder. Int J Neuropsychopharmacol. 2013 Oct;16(9):1959–73. https://doi.org/10.1017/S1461145713000357

Tucha L, Tucha O, Sontag TA, Stasik D, Laufkötter R, Lange KW. Differential Effects of Methylphenidate on Problem Solving in Adults With ADHD. J Atten Disord. 2011;15(2):161-173. https://doi.org/10.1177/1087054709356391

Vidal Estrada R, Bosch Munso R, Nogueira Morais M, Casas Brugue M, Ramos Quiroga JA. Psychological treatment of attention deficit hyperactivity disorder in adults: a systematic review. Actas Esp Psiquiatr. 2012 May-Jun;40(3):147-154.

Milioni ALV, Chaim TM, Cavallet M, Moleda de Oliveira N, Annes M, Dos Santos B, et al. High IQ May “Mask” the Diagnosis of ADHD by Compensating for Deficits in Executive Functions in Treatment-Naïve Adults With ADHD. J Atten Disord. 2017 Oct;21(6):455-464. https://doi.org/10.1177/1087054714554933

Antshel KM, Faraone SV, Maglione K, Doyle AE, Fried R, Seidman LJ, et al. Executive functioning in high-IQ adults with ADHD. Psychol Med. 2010 Jan;40(11):1909–18. https://doi.org/10.1017/S0033291709992273

Schuck SEB, Crinella FM. Why Children with ADHD Do Not Have Low IQs. J Learn Disabil. 2005 May;38(3):262-280. https://doi.org/10.1177/00222194050380030701

Reader MJ, Harris EL, Schuerholz LJ, Denckla MB. Attention deficit hyperactivity disorder and executive dysfunction. Dev Neuropsychol. 1994 Jan;10(4):493–512. https://doi.org/10.1080/87565649409540598

Szuromi B, Bitter I, Czobor P. Functional impairment in adults positively screened for attention-deficit hyperactivity disorder: The role of symptom presentation and executive functioning. Compr Psychiatry. 2013 Oct;54(7):974–81. https://doi.org/10.1016/j.comppsych.2013.04.002

Torralva T, Gleichgerrcht E, Lischinsky A, Roca M, Manes F. “Ecological” and Highly Demanding Executive Tasks Detect Real-Life Deficits in High-Functioning Adult ADHD Patients. J Atten Disord. 2013 Jul;17(1):11-19. https://doi.org/10.1177/1087054710389988

Surman CBH, Biederman J, Spencer T, Miller CA, Petty CR, Faraone SV. Neuropsychological Deficits Are Not Predictive of Deficient Emotional Self-Regulation in Adults With ADHD. J Atten Disord. 2015 Mar;19(12):1046-1053. https://doi.org/10.1177/1087054713476548

Faraone SV, Biederman J, Doyle A, Murray K, Petty C, Adamson JJ, et al. Neuropsychological Studies of Late Onset and Subthreshold Diagnoses of Adult Attention-Deficit/Hyperactivity Disorder. Biol Psychiatry. 2006 Nov;60(10):1081–7. https://doi.org/10.1016/j.biopsych.2006.03.060

Kamradt JM, Ullsperger JM, Nikolas MA. Executive function assessment and adult attention-deficit/hyperactivity disorder: tasks versus ratings on the Barkley deficits in executive functioning scale. Psychol Assess. 2014 Dec;26(4):1095-105. https://doi.org/10.1037/pas0000006

Rincón Lozada CF. Sluggish Cognitive Tempo: Una Nueva Dimensión del TDAH o una Entidad Nosológica Independiente. Rev Mex Investig Psic. 2016 Dec;8(2):192-8. https://doi.org/10.32870/rmip.vi.577

Kamradt JM, Momany AM, Nikolas MA. Sluggish Cognitive Tempo Symptoms Contribute to Heterogeneity in Adult Attention-Deficit Hyperactivity Disorder. J Psychopathol Behav Assess. 2017 Oct;40(2):206–23. https://doi.org/10.1007/s10862-017-9631-9

Becker SP, Barkley RA. Sluggish cognitive tempo: the need for global inquiry. World Psychiatry. 2019 May;18(2):237–8. https://doi.org/10.1002/wps.20639

Gisbert L, Richarte V, Corrales M, Ibáñez P, Bosch R, Bellina M, et al. The Relationship Between Neuropsychological Deficits and Emotional Lability in Adults With ADHD. J Atten Disord. 2019 Oct;23(12):1514-25. https://doi.org/10.1177/1087054718780323

Surman CBH, Biederman J, Spencer T, Yorks D, Miller CA, Petty CR, et al. Deficient Emotional Self-Regulation and Adult Attention Deficit Hyperactivity Disorder: A Family Risk Analysis. Am J Psychiatry. 2011 Jun;168(6):617–23. https://doi.org/10.1176/appi.ajp.2010.10081172

Bunford N, Evans SW, Langberg JM. Emotion Dysregulation Is Associated With Social Impairment Among Young Adolescents With ADHD. J Atten Disord. 2018 Mar;22(1):66-82. https://doi.org/10.1177/1087054714527793

Bunford N, Evans SW, Wymbs F. ADHD and Emotion Dysregulation Among Children and Adolescents. Clin Child Fam Psychol Rev. 2015 Sep;18(3):185-217. https://doi.org/10.1007/s10567-015-0187-5

Tamm L, Epstein JN, Lisdahl KM, Molina B, Tapert S, Hinshaw S, et al. Impact of ADHD and cannabis use on executive functioning in young adults. Drug Alcohol Depend. 2013 Dec;133(2):607-14. https://doi.org/10.1016/j.drugalcdep.2013.08.001

Shaw P, Eckstrand K, Sharp W, Blumenthal J, Lerch JP, Greenstein D, et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proc Natl Acad Sci U S A. 2007 Dec;104(49):19649-654. https://doi.org/10.1073/pnas.0707741104

Stern A, Pollak Y, Bonne O, Malik E, Maeir A. The Relationship Between Executive Functions and Quality of Life in Adults With ADHD. J Atten Disord. 2017 Feb; 21(4):323-30. https://doi.org/10.1177/1087054713504133

Gray SA, Fettes P, Woltering S, Mawjee K, Tannock R. Symptom Manifestation and Impairments in College Students With ADHD. J Learn Disabil. 2016 Nov;49(6):616-30. https://doi.org/10.1177/0022219415576523

Barkley RA, Fischer M. Predicting impairment in major life activities and occupational functioning in hyperactive children as adults: self-reported executive function (EF) deficits versus EF tests. Dev Neuropsychol. 2011 Feb;36(2):137-61. https://doi.org/10.1080/87565641.2010.549877

Strakowski SM, Fleck DE, DelBello MP, Adler CM, Shear PK, Kotwal R, et al. Impulsivity across the course of bipolar disorder. Bipolar Disord. 2010 May; 12(3):285-97. https://doi.org/10.1111/j.1399-5618.2010.00806.x

Silva KL, Guimarães-da-Silva PO, Grevet EH, Victor MM, Salgado CA,Vitola ES, et al. Cognitive Deficits in Adults With ADHD Go Beyond Comorbidity Effects. J Atten Disord. 2013 Feb;17(6):483-88. https://doi.org/10.1177/1087054711434155

Silva KL, Rovaris DL, Guimarães-da-Silva PO, Victor MM, Salgado CA, Vitola ES, et al. Could comorbid bipolar disorder account for a significant share of executive function deficits in adults with attention-deficit hyperactivity disorder? Bipolar Disord. 2013 Nov;16(3):270–6. https://doi.org/10.1111/bdi.12158

Barkley RA, Murphy KR. Impairment in occupational functioning and adult ADHD: the predictive utility of executive function (EF) ratings versus EF tests. Arch Clin Neuropsychol. 2010 May; 25(3):157-173. https://doi.org/10.1093/arclin/acq014

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