Strategies for ensuring positive transition for individuals with attention-deficit/hyperactivity disorder

Abstract

BACKGROUND:

Numerous studies have determined the prevalence of attention-deficit/hyperactivity disorder (ADHD) to range from 5% to 12% of school-age children and adolescents. Moreover, symptoms of ADHD, such as inattentiveness, impulsivity, and distractibility, continue well into adulthood, negatively impacting the individual’s social, educational, and vocational development. Specifically, compared to their peers without ADHD, young adults with ADHD are more likely to drop out of school and fail to pursue post-secondary education, cultivate social relationships, and obtain and maintain competitive employment.

OBJECTIVE:

This article focuses on the transition-related needs of youth with ADHD.

CONCLUSION:

The authors make the point that transition services should (a) be coordinated between school-based (e.g., special educators) and community-based (e.g., vocational rehabilitation counselors) professionals and (b) focus upon the unique skills of each student.

Keywords

Attention Deficit Hyperactivity Disorder transition Vocational Rehabilitation intervention

1 Introduction

Individuals with attention-deficit/hyperactivity disorder (ADHD), by definition, display increased difficulties with attention and/or impulse control and hyperactive behavior in comparison to most individuals of the same age and gender (American Psychiatric Association [APA], 2013). Although individuals may display similar difficulties with the broad behavioral sequelae, ADHD presents as a heterogeneous disorder; and, individual manifestations of this disabling condition may be somewhat idiosyncratic. Thus, every case of ADHD should be treated using an individualized approach. Although the cause of ADHD is unknown, impairment in executive functioning is considered to be the underlying reason for symptoms (Field, Parker, Sawilowsky & Rolands, 2013). Executive functioning is the “self-regulating mechanism for organizing, directing, and managing other cognitive activities, emotional responses, and overt behaviors” (Field et al., p. 67). For individuals with ADHD, deficits with executive functioning translate to difficulties with: (a) activation (i.e., organizing and initiating tasks); (b) focus (i.e., sustaining and shifting attention); (c) effort (i.e., regulating alertness and adjusting speed of processing); (d) emotion (i.e., managing frustrations and controlling intense emotional responses); (e) memory (i.e. retaining, retrieving, and working with information); and (f) action (i.e., initiating, monitoring, and adjusting effort (Field et al., 2013; Nigg & Barkley, 2014).

2 Diagnostic criteria and ADHD symptoms

The most recent diagnostic criteria for ADHD, as defined in the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5; APA, 2013), characterizes ADHD as a persistent pattern of inattention and/or hyperactivity that results in performance issues in social, educational, and work settings. ADHD symptoms include, but are not limited to, difficulty holding attention, distractibility, forgetfulness, talking excessively, interrupting or intruding on others, or difficulty taking part in leisure activities quietly. Diagnosis requires the presence of symptoms that are evident in more than one setting (e.g., home, school, work; APA, 2013). Although such symptoms initially appear early in childhood, they can continue through adolescence and adulthood, resulting in marked impairment in social and vocational functioning.

Contemporary understanding of this disorder includes two distinct, yet substantially correlated, behavioral dimensions underlying the various symptoms thought to characterize ADHD: (a) inattention and (b) hyperactive-impulsive behavior (Nigg & Barkley, 2014; Wilcutt et al., 2005). Diagnosis typically involves examining these two sets of core symptoms and determining whether the disorder is predominantly related to either set or a combination. That is, the core symptoms can appear as distinct, such that an individual with ADHD possesses largely one set of behavioral symptomatology (e.g., inattention) and not the other (e.g., hyperactive-impulsive behavior), or as a combination of both (e.g., inattention and hyperactive-impulsive behavior).

2.1 Inattention

The greatest difficulty that individuals with ADHD demonstrate is the inability to sustain attention or persist at tasks and to resist distractions while doing so (Fischer et al., 2005; Nigg & Barkley, 2014). Failure to sustain attention often leads to a host of complaints by parents, teachers, and even co-workers, who frequently indicate that the individual is easily distracted, does not listen, and cannot concentrate. Research examining the inattention domain has corroborated such complaints through demonstrations of increased off-task behavior, less persistence in performing tedious functions, and less likelihood of returning to an activity once distracted (e.g., Borger & van der Meere, 2000; Fischer et al., 2005), behaviors that are not observed in those with other disabilities or psychiatric conditions (e.g., Swaab-Barneveld et al., 2000).

Overall, inattention in ADHD is characterized by behaviors such as becoming easily distracted by extraneous stimuli; failing to pay close attention to details; making careless mistakes in school or work; difficulty sustaining attention during lectures, lengthy readings, or conversations; appearing as not listening when spoken to directly; trouble following through with instructions and completing school or work assignments; difficulty organizing tasks (exemplified by poor management of sequential tasks, disorganization, poor time management, and meeting deadlines); avoiding tasks that require sustained mental effort; and displaying frequent forgetfulness for daily activities. It is not uncommon for others to misinterpret the inability of individuals with ADHD to sustain attention and, therefore, concentrate effort to complete tasks as “laziness, irresponsibility, or failure to cooperate” (APA, 2013, p. 63). Such public perceptions can undermine the mental and physical health of individuals with ADHD when these individuals also question the legitimacy of their disabilities and, as a result, fail to seek treatment, rehabilitation, or accommodations (both postsecondary and workplace). Individuals with ADHD also are affected by stigma, and they may develop compensatory strategies to mask their difficulties but suffer from the stress and constant effort of trying to maintain a socially acceptable façade (APA, 2013).

2.2 Hyperactive-impulsive behavior

A second area of behavioral difficulty that individuals with ADHD may experience is inhibiting impulses. Simply stated, individuals with ADHD may not possess the ability to stop a behavior once they are ready to engage in that behavior. This inability means that an individual with ADHD may move about constantly, including at inappropriate times, or make hasty, “in the moment” decisions that may result in negative consequences. Over time, hyperactivity declines by adolescence or adulthood, symptoms may be expressed more as restlessness rather than excessive, uncontrollable behaviors (Nigg & Barkley, 2014). On the other hand, impulsivity appears to remain elevated over time but is usually displayed more as improper decision-making/problem-solving (Fischer et al., 2005).

Hyperactivity-impulsivity is characterized by behaviors such as frequent fidgeting, hand tapping, or inability to sit still; leaving seats in classroom or workplace situations when expected to remain in place; feeling restless; frequent inability to quietly engage in play or leisure activities; inability or discomfort with remaining still for extended periods of time such as in restaurants or in lengthy work meetings; talking excessively; difficulty waiting; blurting out answers before questions have been completed; and interrupting others who are speaking or intruding into or taking over what others are doing without permission (APA, 2013). Some research points to the notion that hyperactivity-impulsivity in ADHD can be thought of as a heightened valuation of a reward rather than a pure inability to inhibit behaviors (Sagvolden, Russell, Aase, Johansen & Farshbaf, 2005). That is, the notion of receiving an immediate reward (e.g., receiving $25 now) possesses a higher influence relative to a delayed reward (e.g., receiving $200 in a week). In such a mechanism, behaviors tend to center on a more impulsive style.

2.3 Comorbid psychiatric conditions

Individuals with ADHD often have other, co-occurring disabling conditions. In fact, up to 44% of children with ADHD have at least one other disorder; and 43% have at least two or more additional disorders (Wilcutt et al., 2012). Such rates also are true for adults with ADHD (Barkley, Murphy & Fischer, 2008). Comorbid conditions include anxiety disorders, mood disorders, substance use disorders, and antisocial and other personality disorders (e.g., Loeber, Burke & Pardini, 2009; Molina & Pelham, 1999; Shatz & Rostain, 2006). If untreated, psychiatric comorbidities can amplify the difficulties that individuals with ADHD experience in social interactions, education, and employment.

2.4 Developmental course

Depending on the number and severity of symptoms and the degree to which they impair social or occupational functioning, ADHD may be diagnosed as mild, moderate, or severe. As children with ADHD develop into adolescents, they may experience marked impairment in social and vocational functioning. For example, in comparison to their peers, adolescents with ADHD score lower on standardized tests (despite the fact that they have the cognitive abilities to score higher), have higher absenteeism rates, are at greater risk for dropping out of high school, and are less likely to pursue postsecondary education (DuPaul, Weyandt & Janusis, 2011). Those who do pursue postsecondary education earn lower grade point averages (GPAs) than their peers and demonstrate higher dropout and academic probation rates. As adults, individuals with ADHD often demonstrate increased adverse health outcomes, including fewer friends, social impairments, impulsive decision-making, driving risks and motor vehicle accidents, disturbances in sleep, substance use disorders, difficulties in romantic relationships, and increased rates of criminal activity (O’Driscoll, Heary, Hennessey & McKeague, 2012; Nigg, 2013).

2.5 Epidemiology

Although population estimates vary, most indicate that the prevalence of ADHD in school-aged children and adolescents is between 5% and 12% (APA, 2013; Rowland et al., 2015). Among adults, the prevalence of ADHD ranges from 2.5% to 5% (Barkley, 2012). ADHD is more common in male than in females; however, females with ADHD are more likely than males to present with inattentive features (APA, 2013). Though it has been suggested that the prevalence of ADHD has risen, it is unclear whether a true growth in prevalence exists or is the result of other factors such as changes in diagnostic criteria, increased public awareness, greater access to services, policy changes in special education, and the influence of the pharmaceutical industry on diagnostic practices (Centers for Disease Control and Prevention [CDC], 2014; Polanczyk et al., 2007). However, in a recent analysis, no evidence was found to support the notion that rates of ADHD are increasing in the population when standard diagnostic procedures were used (Erskine et al., 2014). Regardless of any real or supposed increase in the rates of ADHD, recent data from the National Survey of Children’s Health indicates that the proportion of children who have ever been diagnosed with ADHD increased from 7.8% in 2003 to 9.5% in 2007, then to 11.0% in 2011 (CDC, 2014).

3 Outcomes achieved by individuals with ADHD

In recent years, numerous studies have found that for many individuals with ADHD, symptoms persist well into adulthood (e.g., Mannuzza, Klein, Bessler, Malloy & LaPadula, 1998; Safren, Sprich, Cooper-Vince, Knouse & Lerner, 2010; Weiss & Hechtman, 1993). Further, these symptoms have a deleterious impact on the outcomes achieved in multiple domains of adult life. For instance, individuals with ADHD typically achieve significantly lower educational outcomes than their peers without ADHD. In fact, Barkley, Fischer, Smallish, and Fletcher (2006) found that 13% of individuals with ADHD between the ages of 19 and 25 were expelled, 42% were retained at least one grade, and 32% failed to graduate high school. This was compared to 5%, 13%, and 0% of a control group of peers without ADHD. Barkley et al.’s findings mirror those obtained by other authors (e.g., Biederman, Faraone, Spencer, Mick, Monuteaux & Aleardi, 2006; Currie & Stabile, 2006; Mannuzza et al., 1998).

Further, as is true with children with ADHD, adolescents and adults with ADHD typically demonstrate underdeveloped social skills. As a result, individuals with ADHD tend to have lower self-esteem, fewer friends, and greater difficulty maintaining friendships than peers without ADHD (Barkley et al., 2006; de Graaf et al., 2008; Halmoy, Fasmer, Gillberg, & Haavik, 2009; Weiss & Hechtman, 1993). Likewise, research has documented that, in comparison to children without ADHD, those with ADHD are more likely to be socially rejected by their peers and have greater difficulties in establishing friendships (DuPaul et al., 2011). Symptomatic behaviors associated with ADHD (e.g., social skills deficits) contribute to these negative perceptions, rejection, and bullying by peers. Relationship difficulties can cause feelings of isolation, being different, and feeling left out, and these difficulties often persist into adulthood. Family discord can occur in response to ADHD behaviors, and as adults, individuals with ADHD are likely to experience substantial interpersonal conflict (APA, 2013). They also are more likely to have a history of criminal activity and run-ins with the law (Hensen, Weiss & Last, 1999).

Perhaps due to lower educational attainment and poor social skills, ADHD appears to adversely impact vocational outcomes. Though the literature on the subject is emerging, the research that is available appears to suggest that individuals with ADHD are less likely to be employed than individuals without ADHD (Barkley et al., 2006; Biederman et al., 2006; de Graaf et al., 2008). Estimates of employment among individual with ADHD range from 22% to 54% (Holwerda et al., 2013). Moreover, when they do obtain employment, individuals with ADHD are more likely to receive reports of poor work performance, quit, change jobs, or be laid off (Safren et al., 2010; Weiss & Hechtman, 1993). Those who maintain employment often work part-time, in lower status jobs, and earn approximately 30% less than workers without ADHD (Fletcher, 2013), which may explain why adults with ADHD receive governmental subsidies at higher rates than the rest of the population (Currie, Stabile, Manivogn & Roos, 2010). Because of these poor employment outcomes, many young adults with ADHD may benefit from Vocational Rehabilitation (VR) services.

4 Need for supportive Vocational Rehabilitation (VR) services

VR is a state-federally funded program offered throughout the United States and its territories. The goal of VR is to facilitate community-based, competitive employment for individuals with disabilities. Individuals are eligible for VR services if they have a disability that adversely impacts the acquisition or maintenance of employment. Services offered include, but are not limited to: vocational assessment, training, and job development and placement. The effectiveness of VR services has been well documented throughout the literature. Numerous studies have explored VR’s history, policies, and impact on employment outcomes for individuals with diverse disabilities, such as deaf-blindness, mental health issues, autism spectrum disorders and mobility impairments. However, to date, very little is known regarding VR services as they apply to individuals with ADHD. According to data provided by the Rehabilitation Services Administration (2013), 34,549 transition-age young adults with ADHD applied for VR services in 2013. How many of these applicants qualified for, and received, services is unclear, as are the characteristics of these individuals or what outcomes they achieved as the result of VR services. Still, the utilization of VR services may play an important part in the transition planning process for students with ADHD.

5 Implications for transition and VR planning

5.1 Intervention in schools

Early intervention and service provision throughout primary and secondary education are hallmarks of effective treatment for children and youth with ADHD and can facilitate better outcomes in adulthood (DuPaul et al., 2011). The most commonly used interventions are a combination of pharmacological and non-pharmacological interventions. FDA approved psycho-stimulants (e.g., methylphenidate) are the most commonly prescribed medications. Doses of medication are titrated (adjusted) to achieve maximum benefit with minimal adverse effects. Non-pharmacological interventions include evidence-based parent- or teacher-administered behavioral strategies that focus on attention management training, conflict resolution skills, compliance training, and social skills training (e.g., Barkley, 2013; Jenson, Rhode, & Reavis, 2009; Rhode, Jenson & Reavis, 2010). In research conducted in the Netherlands by Stoutjestijk (2016), positive behavior reinforcement combined with emotional support was the pedagogical strategy found to result in the greatest improvements in behavioral functioning. Based on this finding, the author recommended that emotional support be incorporated into all interventions used with students with ADHD. Home-school communication between teachers and parents or adult guardians is critical to ensure that these strategies are consistently implemented in both settings. Likewise, partnerships among teachers, parents, and school psychologists (who recommend strategies) are critical.

School-based transition planning for individuals with ADHD should begin as early as possible (ideally before the required age of 16). Because symptoms of ADHD can have a negative impact on educational and social outcomes, it is vital for educational teams to determine what instructional and educational experiences will help the individual prepare for the transition from school to adult life. When becoming involved in the transition process, VR professionals can help the individuals with ADHD invest in their future by encouraging them to play a key role in planning their own career paths. This assistance may include, but is not limited to, discussions with teachers, school support staff, career centers, community members, and other health care professionals to request additional help or learning accommodations, goals, and/or classroom structure. Throughout the school year, VR professionals and transition specialists must encourage the individual with ADHD to meet with school support team members to monitor progress, receive emotional support and encouragement, and make appropriate changes when necessary.

5.2 Ensuring long-term success through counseling and guidance

As has been indicated, deleterious effects of ADHD are often evident in adult populations. To that end, emotional support and employment assistance may be necessary on a long-term basis to ensure long-term success. Counseling and guidance is a service that is provided by the state-federal VR professionals to all clients throughout the VR process, and emphasizes emotional support, encouragement, and rapport-building. This relationship is based on mutual bonds and respect, equality, agreed upon tasks, and support of clients in identifying and pursing their self-determined goals. Wadsworth and Harper (2007) provided helpful recommendations for counseling individuals with ADHD in a manner that increases the likelihood of a strong working alliance. First, the focus of counseling should be on empowering individuals with ADHD to manage their symptoms and functional difficulties. Due to long histories of academic and vocational failures and troublesome relationships, adults with ADHD may experience self-blame, frustration, and helplessness. Consequently, they may avoid situations that historically have been problematic. Rehabilitation professionals should assist the individual to reframe such negative experiences as symptoms of their disorder rather than personal failures. Essentially, VR professionals should engage the individual using cognitive behavioral therapy (CBT) approaches that aim to change negative or irrational thought patterns that get in the way of staying on task or getting things done (Solanto, 2011).

Second, it is recommended that structured, directive counseling approaches are used rather than insight-oriented, non-directive approaches (Wadsworth & Harper, 2007). Counseling approaches should focus on establishing clear guidelines regarding the rehabilitation process, the importance of being on time for appointments, and both the rehabilitation consumer’s and counselor’s responsibilities. At times, the consumer may perceive the VR professional as too controlling. To counter this negative perception, the VR professional can emphasize that the rehabilitation consumer is an equal partner who has the final say regarding service options and rehabilitation goals. This emphasis, if repeatedly stated and coupled with questions about what the consumer’s preferences are, could assuage the consumer’s perception of the VR professional as being too controlling. Wadsworth and Harper (2007) also delineated ADHD symptoms that may be observable in counseling sessions and cautioned VR professionals not to misinterpret these as disinterest, lack of motivation, uncooperativeness, defiance, and/or immaturity. Examples of these symptoms include long pauses in speech, stopping in the middle of a sentence, forgetting what they were saying, asking the rehabilitation counselor to repeat what she or he was saying, staring into space rather than looking at the rehabilitation counselor, interrupting the rehabilitation counselor when he or she is speaking, and wandering around or leaving the VR professional’s office.

5.3 Planning for college, career, and beyond

Depending on the timing of involvement, VR professionals will want to make sure that an individual who is benefitting from an Individualized Education Plan (IEP) and/or 504 plan in high school documents the nature and extent of such services prior to graduation. Colleges, vocational training programs, and workplace environments may require such records for review before they provide similar types of accommodations and/or services. It is important for VR professionals to collaborate with the educational team to identify goals and services necessary to make the transition. To be optimally effective, VR professionals must develop measurable post-secondary goals (e.g., “After high school, Sergio will enroll in courses at Bay Harbor College” or “Arthur will attend skills training courses in auto mechanics at Ocean Community College”). In addition to setting measurable goals, VR professionals should work with the individual with ADHD to develop a transition assessment portfolio that records data and maintains ongoing dialogue between the individual, case managers, and other relevant individuals.

At this stage, it is vital that VR assessment and planning take an individualized approach, especially due to the heterogeneity of individuals with ADHD. Essential to designing and implementing individualized supports and services for individuals with ADHD, rehabilitation professionals should create as many opportunities for the individual to exert control through choice making (allowing an individual to select an activity among several alternatives) and preference (those activities that are most appealing to the individual) into the rehabilitation process. Once the individual has identified naturally rewarding activities, the VR professional should co-develop with the client a specific support plan (i.e., individualized plan for employment [IEP] that includes: (a) individualized instruction, (b) functional programming, (c) data-based instruction provided within a structured environment, (d) emotional support and encouragement, and (d) collaboration with families and other service providers. Such support plans should focus on those characteristics of social skills, behavioral regulation, and academic and/or employment skills needed to support the individual with ADHD to be successful in his or her chosen path to employment and other adult roles.

5.4 Postsecondary support

As the number of individuals with ADHD attending colleges and universities grows, so too does the need for postsecondary supports. Postsecondary supports and accommodations that have been identified as instrumental to the academic success of students with ADHD include course specific strategic instruction for academic achievement, assistive software programs for enhancing reading compression, extended time on tests in distraction-free environments (e.g., testing centers), books on tape, and note taking assistance (DuPaul et al., 2011).

In addition to the aforementioned array of services, ADHD coaching for improving executive functioning skills and enhancing self-regulation has received increasing attention in recent years (e.g., Field, Parker, Sawilowsky & Rolands, 2013). The focus of coaching is on the development of specific executive functioning skills such as goal setting, confidence building, organizing, problem solving, and persistence at completing tasks. ADHD coaches work with students to set goals based on an accurate self-awareness of their ADHD, its symptoms, and how symptoms affect their thoughts and behaviors. In goal-setting, coaches foster goal achievement by helping students to develop greater self-awareness by teaching strategies to stop, reflect, and take action. They also work with students to identify both individual and environmental factors that support or restrict goal achievement and work with them to develop strategies to activate supportive factors and ameliorate restrictive factors. The student with ADHD, who is held accountable for achieving her or his goals and directs this process. However, ADHD coaches offer suggestions and guidance, set structure, provide support, and help students implement strategies for skill building.

5.5 Job development and placement

Once all services on the IPE have been completed, the next step is job development and placement. As is true of all VR services, job development and placement assistance is highly individualized and takes into consideration each individual client’s unique preferences, skills, ambitions, and needs. However, several issues for providing this service to individuals with ADHD warrant consideration:

The need for on-going emotional support and encouragement from the VR professional during the highly stressful period of searching for, finding. and beginning a new job cannot be overstated.

The same services that can assist the individual with ADHD to succeed in school and postsecondary education (e.g., medication, behavioral interventions, emotional support) can be useful services to include in plans for job development, placement, and retention.

Individuals with more severe ADHD symptoms may benefit from supported employment services that are based on the individualized placement and supports (IPS) model.

Although some individuals with ADHD will be capable of performing independent job searches, others will need more intensive supports such as assistance locating potential jobs, instruction in resume writing and filling out job applications, and practice with mock job interviews to gain skills in emphasizing (but not overstating) one’s qualifications. In some cases individuals may even need a placement specialist to attend interviews with them to assist them in communicating their qualifications.

Self-employment may be an option for some, and these individuals should be referred to business mentors to assist them with developing realistic business plans.

5.6 Accommodation planning

In accommodation planning with individuals with ADHD, the first steps are to review accommodations they have used in secondary and postsecondary classrooms, evaluate their satisfaction with these accommodations, and determine if accommodations they found to be satisfactory can be implemented or adapted for implementation for the specific jobs. Then additional accommodations can be explored as necessary. A variety of accommodations that employers can easily implement to address work-related problems and improve the job performance of workers with ADHD have been recommended (see Adamou et al., 2013). These accommodation ideas include: (a) providing a private office or workstation that is located in a quiet area to limit distractions; (b) developing a buddy system whereby co-workers help individuals with ADHD remain focused; (c) allowing productive movements at work and encouraging employees with ADHD to remain active throughout to day to limit hyperactive impulses; (d) providing alarms, structured notes, and/or regular supervision to improve time management; and (e) delegating more tedious tasks to co-workers or providing incentives for task completion.

6 Conclusion

The need for transition planning for individuals with ADHD is self-evident. Individuals with ADHD tend to have numerous symptoms that adversely impact their ability to not only succeed academically, but also socially and vocationally. Further, there is substantial evidence to indicate that young adults with ADHD have difficulty transitioning from school to adult life—they are more likely to drop out of school, be unemployed, and receive government subsidies than their peers without ADHD. However, many critical questions remain regarding the transition services received by young adults with ADHD. For example: Are school personnel referring students with ADHD to the VR program? What transition-related services do youth with ADHD receive? Are employment outcomes improving? By understanding the services utilized by youth with ADHD, and the outcomes they achieve, rehabilitation and education professionals will be in a better position to assist youth with ADHD to make the transition from school to adult life.

Conflict of interest

None to report.

References

Adamou

, Arif

, Asherson

, Aw

, Bolea

, Coghill

, & … Young

(2013). Occupational issues of adults with ADHD. BMC Psychiatry, 13, 1–7.

American Psychiatric Association (APA). (2013), Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Barkley

R. A.

(2013), Defiant children: A clinician’s manual for assessment and parent training. New York, NY: Guilford Press.

Barkley

R. A.

(2012). Distinguishing sluggish cognitive tempo from attention deficit hyperactivity disorder in adults. Journal of Abnormal Psychology, 121, 978–990.

Barkley

R. A.

, Fischer

, Smallish

, & Fletcher

(2006). Young adult outcome of hyperactive children: Adaptive functioning in major life activities. American Academy of Child and Adolescent Psychiatry, 45, 192–202.

Barkley

R. A.

, Murphy

K. R.

, & Fischer

(2008), ADHD in adults: What the science says. New York: Guilford Press.

Biederman

, Faraone

S. V.

, Spencer

T. J.

, Mick

, Monuteaux

M. C.

, & Aleardi

(2006). Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. Journal of Clinical Psychiatry, 67, 524–540.

Borger

, & van der Meere

(2000). Motor control and state regulation in children with ADHD: A cardiac response study. Biological Psychology, 51, 247–267.

Centers for Disease Control and Prevention (CDC). (2014). Key findings: Trends in the parent-report of health care provider diagnosis and medication treatment for ADHD: United States, 2003-2011. Author.

10.

Currie

, & Stabile

(2006). Child mental health and human capital accumulation: The case of ADHD. Journal of Health Economics, 25, 1094–1118.

11.

Currie

, Stabile

, Manivogn

, & Roos

L. L.

(2010). Child health and young adult outcomes. Journal of Human Resources, 45, 517–548.

12.

de Graaf

, Kessler

R. C.

, Fayyad

, ten Have

, Alonso

, Angermeyer

, & … Posada-Villa

(2008). The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: Results from the WHO World Mental Health Survey Initiative. Occupational and Environmental Medicine, 65, 835–842.

13.

DuPaul

G. J.

, Weyandt

L. L.

, & Janusis

G. M.

(2011). ADHD in the classroom: Effective intervention strategies. Theory Into Practice, 50, 35–42.

14.

Erskine

H. E.

, Ferrari

A. J.

, Nelson

, Polanczyk

G. V.

, Flaxman

A.D.

, Vos

, & … Scott

J. G.

(2014). Epidemiological modelling of attention-deficit/hyperactivity disorder and conduct disorder for the Global Burden of Disease Study 2010. Journal of Child Psychology and Psychiatry, 55, 328–336.

15.

Field

, Parker

D. R.

, Sawilowsky

, & Rolands

(2013). Assessing the impact of ADHD coaching services on university students’ learning skills, self-regulation, and well-being. Journal of Postsecondary Education and Disability, 26(1), 67–81.

16.

Fischer

, Barkley

R. A.

, Smallish

, & Fletcher

(2005). Executive functioning in hyperactive children as young adults: Attention, inhibition, response perseveration, and the impact of comorbidity. Developmental Neuropsychology, 27, 107–133.

17.

Fletcher

J. M.

(2013). The effects of childhood ADHD on adult labor market outcomes. Health Economics, 23, 159–181.

18.

Halmoy

, Fasmer

O. B.

, Gillberg

, & Haavik

(2009). Occupational outcome in adult ADHD: Impact of symptom profile, comorbid psychiatric problems, and treatment: A cross-sectional study of 414 clinically diagnosed adult ADHD patients. Journal of Attention Disorders, 13, 175–187.

19.

Hansen

, Weiss

, & Last

(1999). ADHD boys in young adulthood: Psychosocial adjustment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 165–171.

20.

Holwerda

, van der Klink

J. J. L.

, de Boer

M. R.

, Groothoff

J. W.

, & Brouwer

(2013). Predictors of sustainable work participation of young adults with developmental disorders. Research in Developmental Disabilities, 34, 2753–2763.

21.

Jenson

, Rhode

, & Reavis

H. K.

(2009). The tough kid toolbox. Pacific Northwest Publishing.

22.

Loeber

, Burke

, & Pardini

D. A.

(2009). Perspectives on oppositional defiant disorder, conduct disorder, and psychopathic features. Journal of Child Psychology and Psychiatry, 50, 133–142.

23.

Mannuzza

, Klein

, Bessler

, Malloy

, & LaPadula

(1998). Adult psychiatric status of hyperactive boys grown up. American Journal of Psychiatry, 155, 493–498.

24.

Molina

B. S. G.

, & Pelham

W. E.

(1999). Substance use, substance abuse, and LD among adolescents with a childhood history of ADHD. Journal of Learning Disabilities, 34, 333–342.

25.

Nigg

J. T.

(2013). Attention-deficit/hyperactivity disorder and adverse health outcomes. Clinical Psychology Review, 33, 215–228.

26.

Nigg

J. T.

, & Barkley

R. A.

(2014). Attention-deficit/hyperactivity disorder. In Mash

E. J.

& Barkley

R. A.

(Eds.) Child Psychopathology (3rd ed., pp. 75–144). New York, NY: Guilford Press.

27.

O’Driscoll

, Heary

, Hennessey

, & McKeague

(2012). Explicit and implicit stigma towards peers with mental health problems in childhood and adolescence. Journal of Child Psychology and Psychiatry, 53, 1054–1062.

28.

Polanczyk

, de Lima

M.S.

, Horta

B. L.

, Biederman

, & Rohde

L. A.

(2007). The worldwide prevalence of ADHD: A systematic review and metaregression analysis. American Journal of Psychiatry, 164, 942–948.

29.

Rhode

, Jenson

, & Reavis

H. K.

(2010). The tough kid book (2nd ed). Pacific Northwest Publishing.

30.

Rowland

, Skipper

B. J.

, Umbach

D. M.

, Rabiner

D. L.

, Campbell

R. A.

, Naftel

A. J.

, & Sandler

D. P.

(2015). The prevalence of ADHD in a population-based sample. Journal of Attention Disorders, 19, 741–754.

31.

Safren

S. A.

, Sprich

S. E.

, Cooper-Vince

, Knouse

L. E.

, & Lerner

J. A.

(2010). Life impairments in adults with medication-treated ADHD. Journal of Attention Disorders, 13, 524–531.

32.

Sagvolden

, Russel

V. A.

, Aase

, Johansen

E. B.

, & Farshbaf

(2005). Rodent models of attention-deficit/hyperactivity disorder. Biological Psychiatry, 57, 1239–1247.

33.

Shatz

D. B.

, & Rostain

(2006). ADHD with comorbid anxiety: A review of the current literature. Journal of Attention Disorders, 10, 141–149.

34.

Solanto

M. V.

(2011), Cognitive-behoral therapy for adult ADHD: Targeting executive dysfunction. New York, NY: Guilford Press.

35.

Stoutjesdijk

(2016). Behavioral and academic progress of children displaying substantive ADHD behaviors in special education: A 1-year follow-up. Journal of Attention Disorders, 20(1), 21–33.

36.

Swaab-Barneveld

, DeSonneville

, Cohen-Kettenis

, Gielen

, Buitelaar

, & van Engeland

(2000). Visual sustained attention in a child psychiatric population. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 651–659.

37.

Wadsworth

J. S.

, & Harper

D. C.

(2007). Adults with attention-deficit/hyperactivity disorder: Assessment and treatment strategies. Journal of Counseling and Development, 85, 101–109.

38.

Weiss

, & Hechtman

(1993). Hyperactive Children Grown UP. New York: Gilford Press.

39.

Wilcutt

E. G.

, Doyle

A. E.

, Nigg

J. T.

, Faraone

S. V.

, & Pennington

B. F.

(2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57, 1336–1346.

40.

Wilcutt

E. G.

, Nigg

J. T.

, Pennington

B. F.

, Solanto

M.V.

, Rohde

L. A.

, Tannock

, & … Lahey

B. B.

(2012). Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. Journal of Abnormal Psychology, 121, 991–1010.