ADHD in Adults ADHD IN ADULTS WHAT THE SCIENCE SAYS Russell A. Barkley Kevin R. Murphy Mariellen Fischer THE GUILFORD PRESS New York London © 2008 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved No part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Barkley, Russell A., 1949– ADHD in adults : what the science says / Russell A. Barkley, Kevin R. Murphy, Mariellen Fischer. p. ; cm. Includes bibliographical references and index. ISBN-10: 1-59385-586-9 ISBN-13: 978-1-59385-586-4 (cloth : alk. paper) 1. Attention-deficit disorder in adults. I. Murphy, Kevin R. II. Fischer, Mariellen. III. Title. IV. Title: Attention deficit hyperactivity disorder in adults. [DNLM: 1. Attention Deficit Disorder with Hyperactivity—psychology. 2. Adult. 3. Attention Deficit Disorder with Hyperactivity—diagnosis. 4. Data Interpretation, Statistical. 5. Longitudinal Studies. WM 190 B256ab 2007] RC394.A85B37 2008 616.85′89—dc22 2007028826 To our wives, Patricia Barkley and Bonnie Murphy, in gratitude for their love, support, and creation of a home and family life within which we could achieve our dreams —RUSSELL A. BARKLEY AND KEVIN R. MURPHY With deep appreciation to the participants in our studies, who generously and courageously opened their lives to us so that we all might better understand —MARIELLEN FISCHER About the Authors Russell A. Barkley, PhD, is Clinical Professor of Psychiatry at the Medical University of South Carolina in Charleston and Research Professor of Psychiatry at the State University of New York Upstate Medical University in Syracuse. He was previously Director of Psychology and Professor of Psychiatry and Neurol- ogy at the University of Massachusetts Medical School in Worcester (1985– 2002), where a portion of the original research reported in this volume was con- ducted. A diplomate in three specialties (Clinical Neuropsychology, Clinical Psy- chology, and Clinical Child and Adolescent Psychology, ABCN, ABPP), he has published extensively on attention-deficit/hyperactivity disorder (ADHD) over his 30 years of conducting scientific research on the disorder and related topics. Dr. Barkley served as the principal investigator on the two large research projects reported in this volume (clinic-referred adults with ADHD and hyperactive chil- dren grown up) and has received numerous awards from professional associations for his scientific and clinical contributions and for the public dissemination of psychological science. Kevin R. Murphy, PhD, is founder and Director of the Adult ADHD Clinic of Central Massachusetts in Northborough. He was previously Director of the Adult ADHD Clinic and an Associate Professor of Psychiatry at the University of Massachusetts Medical School in Worcester (1990–2002). He has published extensively on adults with ADHD, often with Dr. Barkley, and consults to numerous legal, educational, and commercial organizations on the clinical diagnosis and management of ADHD in adults. Dr. Murphy served as the coinvestigator on the research study of clinic-referred adults with ADHD reported in this volume and conducted the clinical evaluations of all of the adults in that project. vii Mariellen Fischer, PhD, is a pediatric neuropsychologist and Professor in the Division of Neuropsychology, Department of Neurology, at the Medical Col- lege of Wisconsin in Milwaukee. A diplomate in Clinical Neuropsychology, ABPP/CN, Dr. Fischer has published numerous articles on ADHD, develop- mental psychopathology, and neuropsychology. She and Dr. Barkley have reported the earlier results of the Milwaukee longitudinal study of hyperactive children, the adult outcome of which is presented in this book. Dr. Fischer served as coinvestigator and the Milwaukee site principal investigator on the lon- gitudinal study reported in this volume. viii About the Authors Acknowledgments The research reported here was supported by two grants from the National Institute of Mental Health to Russell A. Barkley while he was at the University of Massachusetts Medical School. The opinions expressed here, however, do not necessarily represent those of the funding institute. We are exceptionally grateful to Tracie Bush for her assistance with the evaluation of the research participants in the study of clinic-referred adults with ADHD reported here and with their data entry. We also wish to thank Laura Montville for her administrative and data entry assistance on this same project. We are just as grateful to Lorri Bauer, Kelli Douville, and Cherie Horan for their assistance with the evaluation of the adult (mean age 27 years) research participants in the Milwaukee longitudinal study reported here; to physician assistants Hope Schrader and Kent Shiffert for their help with participant health evaluations; and to Peter Leo for assistance with data entry. We wish to thank Michael Gordon for his comments on the first three chapters of this book and, more generally, for challenging us to address clinically important controversies using the science-based results of these large research studies and the scientific literature. Last, but hardly least, is the encouragement and support we received from Kitty Moore and Seymour Weingarten at The Guilford Press for this book and for the necessity of placing both research studies in the context of each other and the larger scientific literature relevant to both clinic-referred adults with ADHD and children growing up with ADHD. ix