Why does ADHD seem to run in families?

Part of the reason why ADHD runs in families is down to genetics: ADHD has a high heritability of around 70-80%. What this means is that in an average person with ADHD, 70-80% of the inattention and/or hyperactivity can be explained by contributions of variants in genes. Those variants in genes are not only present in people with ADHD – every person has a few, and each of those variants is neither necessary nor sufficient to cause ADHD. However, the more of those variants a person has, the higher their risk to develop ADHD. The average person with ADHD probably has tens to hundreds of those gene variants in their genetic make-up.

infographic adhd in families

The genetic make-up of a person is determined by the combination of genetic material (i.e. DNA) of their father and mother during conception. The more ADHD-related genetic variants father and mother have in their DNA, the more likely they are to pass some of them on to their children. As indicated above, the number of such variants will be particularly high in those parents that have ADHD themselves. Thus, those with ADHD are likely to have a high-risk genetic make-up and pass it down to their children.

While the genetic make-up provides a good explanation for the observation that ADHD runs in families, there are probably also other factors contributing, some of which may even be family-specific.

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About the Author

Barbara Frank

Barbara Franke is a Professor of Molecular Psychiatry at the Radboud University Medical Center in Nijmegen, The Netherlands. She studies the genetic factors involved in psychiatric disorders, especially ADHD, and investigates the biological pathways that lead from variants in genes to alterations in the brain and to symptoms.


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What is the difference in ADHD between males and females?

When male and female accounts of specific ADHD symptoms are studied, research has found that the symptoms they experience are more alike than different.  When you ask women and men about their lived experiences with ADHD, however, you are likely to find some striking differences. 

Gender differences in ADHD

Certain aspects of ADHD – such as rates of diagnosis and treatment, presentation or “type,” and rates of co-existing depression, anxiety, and behavioral disorders – seem to diverge along gender lines in ways similar to other psychiatric diagnoses. Although, again, the reasons behind these differences are layered and confusing. For instance, women and girls with ADHD tend to have a higher incidence of depression and anxiety. This could, in part, be due to a tendency of girls and women to exhibit internalizing behavior (anxiety, depression, people pleasing) while boys and men in general are more likely to display externalizing behaviors (hyperactivity, disruptive behaviors). There has yet to be an agreed upon reason for this difference in the ADHD community, with some trying to identify neurological reasons by looking at the increased rates of inattentive symptoms for females and hyperactive symptoms of males (nature) and others pointing to the complexities of socialization and gender-based behavioral expectations (nurture). (Yes, that same old debate is alive and well!)

Similarly, and likely for a variety of reasons, boys are diagnosed with ADHD two to three times as often as girls and they are more likely to be diagnosed early in life. Researchers are currently investigating whether there is a true difference in incidence of the condition between males and females, or whether differences in rates of diagnoses are due to other factors such as gender bias or variations in presentation of symptoms. Overall, however, women and girls are less likely to be properly diagnosed with ADHD, with boys and men being more likely than girls and women to be referred for services even when their symptom profiles are exactly the same. 

Further, a number of complex and nuanced factors influence the female experience of ADHD in ways that continue to lack robust research. One example is the impact of estrogen on dopamine, the brain chemical most prominently implicated in ADHD. Fluctuating estrogen levels can impact the intensity and presentation of ADHD symptoms. Women also continue to face gender-role expectations that do not always align favorably with the strengths and challenges of an ADHD brain. They also have higher rates of self-harming behaviors and lower self-esteem than men with ADHD. For all individuals regardless of gender-identity, it is likely that gendered expectations of behavior might complicate how symptoms are perceived.

While it is important to continue to consider the impact of sex differences on ADHD presentation and experience, it is also pivotal that we begin to question the role that gender-based biases and expectations might play in coloring our perception of the strengths and challenges inherent in this condition. To date, the field lacks meaningful research on the experiences of people with ADHD who do not identify as cis-gender.  We all need to be part of the collective story because the more diversity of representation in the research and literature, the more accurately we can diagnose and treat ADHD to help people live well with their differences, not simply in spite of them. 

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About the Author

Michelle Frank

Dr. Michelle Frank is a well-regarded specialist in the diagnosis and treatment of ADHD who aims to help her clients learn how to live successfully with ADHD – and without shame. Dr. Frank is the co-author of A Radical Guide for Women with ADHD: Embrace Neurodiversity, Love Boldly, and Break Through Barriers, written in collaboration with Sari Solden and published by New Harbinger.  Dr. Frank is committed to ADHD advocacy and awareness campaigns, speaking nationally on issues related to ADHD, women’s empowerment, and neurodiversity.


Further reading

  • Mowlem, F.D., Rosenqvist, M.A., Martin, J. et al. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry 28, 481–489 (2019). https://doi.org/10.1007/s00787-018-1211-3
  • Hinshaw SP, Owens EB, Zalecki C, et al. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J
  • Consult Clin Psychol. 2012;80(6):1041-1051. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543865/ Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01596. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195638/

What is the relationship between ADHD and emotional regulation?

During the first 170+ years of its medical history, attention deficit hyperactivity disorder (ADHD) and its precursor disorders were believed to involve deficits in emotional inhibition and self-regulation along with the core problems with attention and hyperactive-impulsive behavior. Yet, beginning in the 1960s, especially with the second edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-II: APA, 1968), the symptoms of emotional impulsiveness (EI) and deficient emotional self-regulation (DESR) were divorced from the core deficits of ADHD, being treated as merely associated problems that may arise in some cases, if these problems were acknowledged at all. This led to most people, clinicians included, excluding emotional self-regulation from their understanding of and theories about the nature of ADHD.

Infographic emotional regulation

Emotional impulsiveness refers to the expression of provoked emotional reactions to events more quickly than is the case in typical people. Being impatient, having a low frustration tolerance, being easily excitable or emotionally aroused, expressing more forceful primary emotions when provoked, quickness to anger, and other impulsive emotional reactions illustrate this deficit in emotion regulation. DESR refers to the inability or difficulty with gaining control over strong emotions that have been provoked by events so as to inhibit their public expression, down regulate or reduce their severity, more quickly engage in efforts at self-calming, and even substitute more moderate emotional reactions that are more conducive to one’s immediate and longer term welfare.

Yet none of the above is to suggest that all of the emotional difficulties seen in a patient with ADHD can be written off to this emotional dysregulation component. ADHD is certainly associated with an elevated risk for various mood and anxiety disorders beyond just impulsive emotions.

What distinguishes affective disturbances of ADHD from comorbid affective disorder

First, consider that the emotional disturbances in ADHD are just that – emotions, and not moods. Emotions are short duration, provoked, and often situation specific to the setting of the provocation. They are also largely rational which is to say understandable to others given that typical people would have had the same subjective reaction to the provocation. But the difference is that the typical person would have acted to suppress the voluntary aspects of the emotion over which they have some volitional control rather than express it publicly. They would then have engaged in the self-regulatory steps to down-regulate or otherwise alter the emotion to make it more compatible with the situation, others, and the person’s longer-term goals and welfare. Recovery from such a provoked change in emotional state can be relatively quick compared to moods, though perhaps not as easily as is seen in typical people given that those with ADHD have more difficulties down-regulating strong emotions using executive self-control.

In contrast, a mood is just that – a long duration change in emotional state that is often cross-situational and may arise without provocation or from trivial events that would often not have led others to react in this fashion. It can be described as capricious as well as extreme. Consequently, it is not rational in the sense that other people would have the same emotional state under these circumstances over such an extended period of time and across settings. Admittedly, the dividing line between an emotion and mood is not as crisp as is portrayed here. But the above guidelines seem sensible at this time to guide clinicians in sorting out what affective symptoms of a patient with ADHD belong to that disorder and its EI-DESR problems and what symptoms are likely to be attributable to a comorbid disorder.

Compelling evidence has arisen over the past decade that clearly shows that many if not most cases of ADHD involve problems with EI and DESR. It also shows that these problems are correlated with the severity of more traditional ADHD symptoms, and that they share the same genetic influences that are well-documented in research on ADHD. The abundant evidence argues for the return of EI-DESR to the status of a key associated feature if not a core component of ADHD in its conceptualization and diagnostic criteria.

The argument is based on various lines of reasoning and evidence:

  1. EI-DESR has a long history of being a central feature of ADHD in its clinical conceptualization well before the 1960s.
  2. Current neuropsychological theories of ADHD consider EI-DESR to be just such a central component.
  3. The neuroanatomical findings associated with ADHD would have to give rise to symptoms of EI-DESR because the brain structures and networks involved in ADHD are also involved in emotion generation, expression, and self-regulation.
  4. Ample evidence now exists that children and adults with ADHD are highly likely to manifest EI-DESR (low frustration tolerance, impatience, quickness to anger, and being easily excited to emotional reactions more generally).
  5. Returning EI-DESR to a central place in ADHD would more clearly show the basis for its high comorbidity with oppositional defiant disorder and probably several related disorders, such as future risk for anxiety and depression.
  6. Promoting EI-DESR as a core component of ADHD would also clarify one basis for the frequent social interaction problems and impairments in several other domains of major life activities (work, driving, marriage/cohabiting, managing finances, and parenting) seen in ADHD.
  7. Understanding the role of EI/DESR in ADHD would greatly assist with differential diagnosis of ADHD from mood disorders and reduce misdiagnosing emotional problems in ADHD as entirely arising from comorbidity.
  8. ADHD medications appear to reduce the EI/DESR evident in ADHD as much as they do the traditional ADHD symptom dimensions, yet each may do so through different neural mechanisms and networks.
  9. Psychosocial interventions for ADHD should include programs targeted at helping patients with EI/DESR specifically rather than just traditional ADHD symptom dimensions.
  10. Doing so is likely to reduce the various impairments that are specifically associated with the emotional component of ADHD that are largely going unaddressed in current therapies.

Regardless of what the next DSM may do, clinicians need to be aware of the EI-DESR symptoms inherent in ADHD and evaluate them as much as they evaluate the traditional ADHD symptoms during their initial assessment of a patient for ADHD. Doing so can provide not just a clearer and more comprehensive account of the patient’s current status, but also a richer understanding of the basis for many of the impairments the patient may be experiencing that are partly or largely a consequence of this emotional component of ADHD. That ADHD includes such a component likewise needs to be explained by clinicians to their ADHD patients and families so they, too, gain such a better, more complete understanding of the condition and why the patient may emote as they do. Interventions also need to be targeted at this component of ADHD besides the ongoing efforts to develop both psychosocial and medical interventions that focus on the traditional symptom complex of ADHD and its related “cold” cognitive executive deficits. Treatment should also focus on how best to help family members cope with and assist the patient with ADHD in the effective management of their emotional dysregulation.

In sum

It is time to return EI-DESR to its rightful place in the core or central components of ADHD and to investigate better ways to treat or manage it if the well-being of those with ADHD is to be improved.

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About the Author

russell barkley

Dr. Barkley is a Clinical professor of Psychiatry at the Virginia Commonwealth University Medical Center in Richmond, Virginia, USA.  He has published more than 27 books, rating scales, and clinical manuals and more than 300 scientific papers and book chapters on ADHD, and has presented more than 800 invited lectures in more than 30 countries.  His latest books are Taking Charge of ADHD: The Complete, Authoritative Guide for Parents (4th ed., June 2020, Guilford press) and The 12 Principles for Raising and Child with ADHD (October 2020, Guilford Press).  His website is www.RussellBarkley.org.

Supportive Scientific References

  • Barkley, R. A. (2015).  Emotional dysregulation is a core component of ADHD. In R. A. Barkley (ed.). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.) (pp. 81-115). New York: Guilford Press.
  • Barkley, R. A. & Fischer, M.  (2010). The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults.  Journal of the American Academy of Child and Adolescent Psychiatry, 49, 503-513.
  • Barkley, R. A. & Murphy, K. R. (2011).  Deficient emotional self-regulation in adults with ADHD: The relative contributions of emotional impulsiveness and ADHD symptoms to adaptive impairments in major life activities.  Journal of ADHD and Related Disorders, 1(4), 5-28.
  • Braaten, E. B., & Rosen, L. A. (2000).  Self-regulation of affect in attention deficit-hyperactivity disorder (ADHD) and non-ADHD bys: differences in empathic responding.  Journal of Consulting and Clinical Psychology, 68, 315-321.
  • Ciuluvica, C., Mitrofan, N., & Grilli, A. (2013).  Aspects of emotion regulation difficulties and cognitive deficit in executive functions related to ADHD symptomatology in children.  Social and Behavioral Sciences, 78,  390-394.
  • Dowson, J. H., & Blackwell, A. D. (2010).  Impulsive aggression in adults with attention-deficit/hyperactivity disorder.  Acta Psychiatrica Scandinnavica, 121, 103-110.
  • Harty, S. C., Miller, C. J., Newcorn, J. H., & Halperin, J. M. (2009).  Adolescents with childhood ADHD and comorbid disruptive behavior disorders: Aggression, anger, and hostility.  Child Psychiatry and Human Development, 40, 85-97.
  • Hinshaw, S. P. (2003).  Impulsivity, emotion regulation, and developmental psychopathology: specific versus generality of linkages.  Annals of the New York Academy of Sciences, 1008, 149-159.
  • Hulvershorn, L., Mennes, M., Castellanos, F. X., Martino, A.D., Milham, A. P., Hummer, T. A., Roy, A. K. (2013).  Abnormal amygdala functional connectivity associated with emotional lability in children with Attention-Deficit/Hyperactivity Disorder.  Journal of the American Academy of Child & Adolescent Psychiatry, 53(3), 351-361.
  • Jensen, S. A., & Rosén, L. A. (2004). Emotional reactivity in children with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 8, 53-61.
  • Maedgen, J. W., & Carlson, C. L. (2000).  Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes.  Journal of Clinical Child Psychology, 29, 30-42.
  • Martel, M. M. (2009).  Research review: A new perspective on attention-deficit/hyperactivity disorder: emotion dysregulation and trait models.  Journal of Child Psychology and Psychiatry, 50, 1042-1051.
  • Melnick, S. M., & Hinshaw, S. P. (2000). Emotion regulation and parenting in AD/HD and comparison boys: linkages with social behaviors and peer preference.  Journal of Abnormal Child Psychology, 28, 73-86.
  • Merwood, A., Chen, W., Rijsdijk, F., Skirrow, C., Larsson, H., Thapar, A., Kuntsi, J., & Asherson, P. (2013).  Genetic association between the symptoms of attention-deficit/hyperactivity disorder and emotional lability in child and adolescent twins.  Journal of the American Academy of Child and Adolescent Psychiatry, 53(2), 209-220.
  • Musser, E. D., Backs, R. W., Schmidtt, C. F., Ablow, J. C., Measelle, J. R., & Nigg, J. T. (2011).  Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD).  Journal of Abnormal Child Psychology, 39, 841-852.
  • Ryckaert, C., Kuntsi, J., & Asherson, P. (2018).  Emotional dysregulation and ADHD.  In Banaschewski, T., Coghill, D., & Zuddas, A. (Eds.).  Oxford Textbook of Attention Deficit Hyperactivity Disorder (pp. 103-117).  London: Oxford University Press.
  • Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014).  Emotion dysregulation in attention deficit hyperactivity disorder.  American Journal of Psychiatry, 171 (3), 276-293.
  • Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Che, W., Franke, B., Holtman, M. et al. (2010).  Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence.  Journal of Child Psychology and Psychiatry, 51, 915-923.
  • Surman, C. B. H., Biederman, J., Spencer, T., Miller, C. A., McDermott, K. M., & Faraone, S. V. (2013).  Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: A controlled study.  ADHD: Attention Deficit Hyperactivity Disorder, 5, 273-281.
  • Walcott, C. M., & Landau, S. (2004).  The relation between disinhibition and emotion regulation in boys with attention deficit hyperactivity disorder.  Journal of Clinical Child and Adolescent Psychology, 33, 772-782.

How common is ADHD in children and adults?

The behaviors that characterize ADHD were described a long time ago, but in clinical practice the diagnosis of ADHD has been used for only 40 years. This was also when ADHD became important in scientific research. Since then many studies have been done around the world to estimate how often ADHD is present in children. Averaged across these studies it has been estimated that around 5.6%, i.e., roughly one in every twenty children, has ADHD. Around the age of 12 years old and further on during adolescence, some of the children with ADHD start to experience fewer symptoms of ADHD. Research findings indicate that by young adulthood, roughly 22% of children have no ADHD symptoms anymore, 43% still have symptoms and impairments in daily life although not as severe as before, and another 35% still have the symptoms and impairments as they had these during childhood.

How common is ADHD in children and adults

For a long time, only children received a diagnosis of ADHD. When it became clear that only a minority of the children ‘lost’ their symptoms and impairments when they reached adulthood, researchers started to investigate how often it was the case that symptoms and impairments remained so severe that the ADHD diagnosis applies. The current best estimate is that ADHD is present between 2.8% to 4.4% of adults. Especially when persisting in adulthood, persons with ADHD may develop additional psychiatric or somatic conditions that have their onset in adulthood, like depression or diabetes. These conditions are more frequent in adults with ADHD compared to adults without ADHD and could potentially be prevented if ADHD could be successfully treated. However, the latter is speculative; this has not yet been fully established by sound scientific research. In addition, there are still very few longitudinal studies examining how ADHD develops during adulthood.

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About the Author

Catharina Hartman

Catharina Hartman is an associate professor of psychiatric epidemiology in the Netherlands. Her research is focused on improving our understanding of childhood-onset psychiatric disorders and their course across the lifespan, in particular ADHD and autism.

Further Reading

Lange KW, Reichl S, Lange KM, Tucha L, Tucha O. The history of attention deficit hyperactivity disorder. Atten Defic Hyperact Disord. 2010; 2(4):241–55. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000907/

Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007; 164(6):942-948. doi:10.1176/ajp.2007.164.6.942 https://ajp.psychiatryonline.org/doi/10.1176/ajp.2007.164.6.942

Fayyad J, Sampson NA, Hwang I, et al. The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. Atten Defic Hyperact Disord. 2017; 9(1):47-65. doi:10.1007/s12402-016-0208-3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325787/

Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006; 163:716–23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859678/

Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, Cormand B, Faraone SV, Ginsberg Y, Haavik J, Kuntsi J, Larsson H, Lesch KP, Ramos-Quiroga JA, Réthelyi JM, Ribases M, Reif A. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol. 2018 Oct;28(10):1059-1088. doi: 10.1016/j.euroneuro.2018.08.001. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379245/

What causes ADHD?

In most people having the diagnosis, ADHD is likely to be the result of their genetic make-up (i.e. their DNA) and events that happen to them throughout (early) life (which we call environmental factors).

ADHD has a high heritability of around 70-80%. What this means is that in an average person with ADHD, 70-80% of the inattention and/or hyperactivity can be explained by contributions of genes. Sometimes I hear people talk about ‘having the ADHD gene’. This is not correct: the average person with ADHD probably has tens to hundreds small variations in different genes. The more of those gene variants a person has, the higher their risk to develop ADHD.

While 70-80% heritability sounds like a lot, genetic factors are certainly not the only factors that are important in developing ADHD. Also environmental factors, in particular events occurring before or during birth, but also stress during childhood, play an important role. Thus, not everybody with a high load of gene variants will actually go on to develop ADHD.

In most cases, a combination of many gene variants and environmental factors is likely involved. There are probably many environmental factors involved in ADHD, which we do not yet know. In addition to those that increase risk for ADHD, there may be also factors that reduce the risk.

The genetic factors (together with environmental factors) involved in ADHD are thought to alter brain development very early in life, probably starting already before birth. However, much research is still needed to

  1. identify all the specific factors involved (e.g., we expect that variants in more than 1000 genes are involved, and we need to get more insight into the environmental factors that increase and reduce ADHD risk) and
  2. to understand, how these factors alter the structure, function, and development of the brain.

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About the Author

Barbara Frank

Barbara Franke is a Professor of Molecular Psychiatry at the Radboud University Medical Center in Nijmegen, The Netherlands. She studies the genetic factors involved in psychiatric disorders, especially ADHD, and investigates the biological pathways that lead from variants in genes to alterations in the brain and to symptoms.


Read more:

About genetic studies in ADHD and heritability:
Faraone SV, Larsson H. Genetics of attention deficit hyperactivity disorder. Mol Psychiatry. 2019 Apr;24(4):562-575. doi: 10.1038/s41380-018-0070-0. Epub 2018 Jun 11. PMID: 29892054; PMCID: PMC6477889. https://www.nature.com/articles/s41380-018-0070-0

About the factors that contribute to ADHD:
Larsson, H. et al. Genetic and environmental influences on adult attention deficit hyperactivity disorder symptoms: a large Swedish population- based study of twins. Psychol. Med. 43, 197–207 (2013).
https://bit.ly/3laz7Yi

About ADHD across the lifespan:
Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, Cormand B, Faraone SV, Ginsberg Y, Haavik J, Kuntsi J, Larsson H, Lesch KP, Ramos-Quiroga JA, Réthelyi JM, Ribases M, Reif A. Live fast, die young? A review on the developmental trajectories of ADHD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379245/

How are ADHD and executive functioning related?

For decades ADHD was seen as just a problem of little kids who couldn’t sit still, wouldn’t shut up, and were driving parents and teachers nuts. Increasingly now ADHD is being understood as a problem of the brain’s self-management system, its “executive functions” which affects not just little kids, but also many teenagers and adults.

How are ADHD and executive functioning related

Executive functions involve getting organized and started on necessary tasks, sustaining focus and effort for work, managing alertness and emotional interference, utilizing short-term working memory, and managing one’s actions without excessive impulsivity. These executive functions are most effectively assessed not by neuropsychological tests, but by careful evaluation of how the child or adult self-manages tasks and interactions of everyday life compared to others of similar age.

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About the Author

Thomas e brown

Thomas E. Brown earned his Ph.D. in Clinical Psychology at Yale University and served on the Yale faculty for 25 years. He is now Director of the Brown Clinic for Attention and Related Disorders in Manhattan Beach, CA, is an elected Fellow of the American Psychological Association, and has published numerous articles and six books on ADHD. His website is www.BrownADHDclinic.com


References

Silverstein, MJ, Faraone, SV, Leon, TL, et al. (2020) Relationship Between Executive Function Deficits and DSM-5 Defined ADHD Symptoms. J of Attention Disorders 24 (1) 41-51

Brown, TE (2006) Executive functions and attention deficit hyperactivity disorder: implications of two conflicting views. International J of Disability, Development and Education. 53 (35-46).

Barkley, RA & Fischer M (2011) Predicting impairments in major life activities and occupational functioning in hyperactive children as adults: Self-reported executive function (EF) deficits versus EF tests. Developmental Neuropsychology 36 (137-161).

Willcutt, EG, Doyle, AE, Nigg, JT, et al. (2005) Validity of the Executive Function Theory of ADHD: A Meta-Analytic Review. Biological Psychiatry 57: 1336-1346.