By Elizabeth Ahmann, ScD, RN, ACC, Research Committee.

Everyone hopes for and tries to achieve a good quality of life! Certainly, it is an underlying concern when clients come to us for coaching, no matter what the pressing concerns may be. Improved time management? Better organization? Closer relationships? Better communication? Success in the workplace? Increased grades in school? All of these potential presenting issues clearly relate to an underlying desire to improve quality of life.

A recent study (Lensing, et al., 2013 – see full citation below) examined quality of life in adults with ADHD. In this Circle article, I will be describing the purpose of this study, explaining a bit about the study design, sharing the study findings, placing this study’s findings in the context of other research on ADHD and quality of life, and raising questions about how you might use the results of this study in your own coaching practice.

The study is from Journal of Attention Disorders, an ACO member benefit:

Lensing, M. B., Zeiner. P., Sandvik. L & Opjordsmoen. (2013), Quality of life in adults aged 50+ with ADHD. Journal of Attention Disorders. Published online before print March 20, 2013, doi: 10.1177/1087054713480035.

Purpose of the study

The purpose of this study (Lensing, et al., 2013), conducted in Norway and Denmark, was to examine quality of life and satisfaction with life for individuals with ADHD. Adults age 50 – 69 with diagnosed ADHD were recruited from a large Norwegian ADHD “patient organization.” Quality of life in these adults was compared with quality of life in same-aged Danish adults in a general population survey; additionally, satisfaction with life in the ADHD subjects was compared to satisfaction with life in a Norwegian population sample.

If you are interested in the study design and a bit about the research process, read on in the next section. If you only want to know what the study found, skip that section and jump ahead!

Study design and study “variables”

The basic design of the study was to examine the impact of ADHD on quality of life/satisfaction with life. So the researchers are looking at the impact of one factor (ADHD) on other factors (quality of life/satisfaction with life).

The design of this study gives us an easy format for looking at and understanding an important aspect of research: study variables. Most studies have several types of “variables” including independent and dependent variables, and sometimes confounding or control variables. Each of these will be described below.

In a research study, an “independent variable” is the ‘causative’ factor or the factor whose impact is being studied. Put another way, the independent variable is a factor the researcher(s) control by the choice of study groups or manipulate in an experimental approach. You could consider this the ‘input’ variable in a study. In this study, ADHD is the independent variable; that is, the study examines the influence or impact of ADHD on other factors.

A second type of study variable is a “dependent variable.” A dependent variable is the response being measured in a study. Another way to think of it is as the outcome variable. You could call it the output of a study or the effect of a study intervention. In this study, the dependent variable is quality of life/ satisfaction with life.

A third type of variable in a research study is a “confounding variable.” Confounding factors or variables are factors that might serve as an alternative explanation for results seen in a study. For example in this study, we might wonder what factors besides ADHD could influence quality of life? (Age? Gender? Income? Other?). Differences in these factors in the ADHD and non-ADHD participants in the study could potentially confuse or confound the findings about the impact of ADHD on quality of life. So, in designing a study, researchers need to consider potential confounding factors and control for them. When this occurs, they may be called control variables.

As an example of confounding variables, this study used a comparison group which

the researchers checked for gender and for age distribution, finding no statistically significant differences on those factors in the ADHD and general population groups.

So, in this way, the authors controlled for the potential confounding effect of the two variables age and gender on quality of life. Are there other confounding variables you think they should have examined or controlled for?

Study Findings

It’s important to note that, in this study on quality of life with ADHD, the average age of the study subjects with ADHD was 55.7 years, and average at diagnosis was 50.2 years, suggesting that many, if not most of the study participants with ADHD had lived much of their lives undiagnosed. That in itself may be an important factor in the subject’s quality of life.

The researchers for this study also did some statistical examination within the ADHD group itself to see what factors might be associated with reduced quality and satisfaction with life. In general they found that non-employment and increased ADHD symptom severity were associated with lower quality of life. Co-occurring disorders also negatively impacted ratings on both the usual activities and health conditions subscales of the quality of life measurement.

In this study, as stated in the abstract:

Adults with ADHD reported significantly reduced health-related quality of life and reduced satisfaction with life compared with population norms. Non[-]employment and severe ADHD were associated with poor quality of life. The negative impact of ADHD persists into late adulthood (Lensing, et al., 2013, Abstract).

Context for Interpreting Study Findings

It is always helpful to place the findings of a single research study in the context of a broader body of research. Agarwal and colleagues (2012) examined 36 studies related to quality of life in individuals with ADHD, reaching similar conclusions to this study: “Attention deficit hyperactivity disorder was found to significantly worsen the quality of life in adults.” (p. 10)

For children, ADHD has also been shown to have a deleterious effect on quality of life (see: http://www.adhd-institute.com/burden-of-adhd/impact-of-adhd/impact-on-quality-of-life/)

Of note, Agarwal and colleagues (2012) found that “Pharmacological treatment and early diagnosis have a positive impact on outcomes, long[-]term prognosis, and quality of life in adults with attention deficit hyperactivity disorder” (p. 10).

Implications for Coaching: Questions and Resources

In your coaching practice, how will you use the findings of this research on quality of life in adults with ADHD? In particular:

  • What information might you share with clients based on this study?
  • What questions might you ask now that you did not ask before?
  • How might you introduce discussion of overall quality of life?
  • What other specific coaching strategies might you apply in your coaching practice based on the findings of this research?

In your coaching practice, are you impacting quality of life for your clients? How will you know?

If you are interested in assessment tools, you might consider looking at quality of life measures to integrate into your practice. Using a quality of life assessment as part of the coaching intake and then some months later could help you look at whether coaching is impacting quality of life for your client(s).

  • In his book Practicing Positive Psychology Coaching, Biswas-Deiner (2010) describes a number of simple approaches to assessing specific aspects of quality of life.
  • In the Agarwal and colleagues (2012) review of studies on quality of life in adults with ADHD, assessment instruments that various studies used are identified.
  • Some ADHD-specific tools to consider are described in the following sources (if these interest you, you may be able to obtain the assessment tools by contacting those who developed them.):

References

Agarwal, R., Goldenberg, M, Perry, R & Ishak, W.W. (2012). The Quality of Life in Adults with Attention Deficit Hyperactivity Disorder: A systematic review. Innov Clin Neurosci, 9(5-6), 10-12. Accessed online at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398685/

Biswas-Deiner, R. (2010). Practicing Positive Psychology Coaching Hoboken, NJ: John Wiley and Sons.

Lensing, M. B., Zeiner. P., Sandvik. L & Opjordsmoen. (2013), Quality of life in adults aged 50+ with ADHD. Journal of Attention Disorders. Published online before print March 20, 2013, doi: 10.1177/1087054713480035.


Liz-Ahmann2Elizabeth Ahmann, ScD, RN, ACC, is a member of the ACO Research Committee, which writes research reviews as a service to ACO members.

Dr. Ahmann works with clients of all ages to help each individual develop the structures, skills, strategies, and self-talk that best support success! She also teaches tele-classes in mindfulness strategies for ADHD. Contact her at LizAhmann.com.