34 Attention-Deficit/Hyperactivity Disorder, Emotion Regulation, and Executive Functioning Associated with Educational and Occupational Outcomes in Adults

Abstract

Objective:

While attention-deficit/hyperactivity disorder (ADHD) symptoms, including inattention, hyperactivity, and impulsivity, are normally distributed within the population, features of ADHD have been associated with poor functional outcomes across various domains of life, such as academic achievement and occupational status. However, some individuals with even strong ADHD features show normal or above-average success within these functional domains. Executive dysfunction and emotion regulation abilities are associated with educational attainment and occupational status and may therefore explain some of the heterogeneity in functional outcomes in individuals with mild, moderate, and high levels of ADHD symptoms. In this study, we investigated whether emotion regulation strategy use (i.e., emotion suppression or cognitive reappraisal) and executive function abilities moderate the relationship between ADHD symptoms and occupational status and education attainment in adults.

Participants and Methods:

Data were collected from 109 adults aged 18 - 85 (M = 38.08, SD = 15.54; 70.6% female) from the Nathan Kline Institute Rockland Sample. All participants completed measures of ADHD symptoms (Conners Adult ADHD Rating Scale), emotion regulation strategy use (Emotion Regulation Questionnaire), and executive functioning (composite scores of inhibition, shifting and fluency from the standardized Delis-Kaplan Executive Function System). In this study, executive function abilities and emotion regulation strategy use were tested as potential moderators of the relationship between ADHD symptoms and functional outcomes using hierarchical regression models.

Results:

Several two- and three-way interactions predicting occupational status and educational attainment were observed. Education attainment was predicted by hyperactivity and reappraisal (ß = -0.26, p = .006); inattention, shifting, and reappraisal (ß = -0.52, p = .029); inattention, shifting, and suppression (ß = -0.40, p = .049); inattention, fluency, and reappraisal (ß = 0.24, p = .038); hyperactivity, fluency, and reappraisal (ß = 0.27, p = .034); and impulsivity, fluency, and reappraisal (ß = 0.44, p = .004). Occupational status was predicted by inattention and reappraisal, (ß = -0.27, p = .032), hyperactivity and reappraisal (ß = -0.26, p = .004); and impulsivity, fluency, and reappraisal (ß = 0.35, p = .031). Fluency was positively associated with educational attainment when controlling for inattention and impulsivity.

Conclusions:

Consistent with the hypothesis, the association between ADHD symptoms and both occupational status and educational attainment were moderated by the interaction between emotion regulation strategy use, executive function abilities domains. The observed interactions suggest that both occupational status and educational attainment may depend heavily on one’s intrinsic abilities and traits. Contrary to previous literature, we found no evidence that ADHD symptoms, emotional regulation strategies were independently associated with either educational attainment or occupational status, but this should be validated in a sample with greater representation of adults with clinically significant ADHD.