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Entrepreneurship and attention deficit/hyperactivity disorder:
a large-scale study involving the clinical condition of ADHD
Daniel A. Lerner &Ingrid Verheul &Roy Thurik
Accepted: 1 December 2017 /Published online: 15 May 2018
#The Author(s) 2018
Abstract A growing conversation has emerged linking
ostensibly dark or pathological individual-level character-
istics to entrepreneurship. Attention deficit/hyperactivity
disorder (ADHD) is among the most central and emblem-
atic. Recent studies have made great strides—articulating
the theoretical relevance of ADHD-type behavior in entre-
preneurship and suggesting a positive link consistent with
narratives in the popular press. However, quantitative stud-
ies have yet to empirically examine ADHD in line with its
theoretical roots and definition—as a clinical disorder. The
present paper contributes by providing a theoretically–
empirically aligned test of the connection between the
condition of ADHD and entrepreneurial intention and
action. Based on a large-scale data collection effort (N=
9869) and cross-sectional methodology, the results find a
positive connection between clinical ADHD and entrepre-
neurial intentions as well as entrepreneurial action. This
grounds prior research on ADHD and entrepreneurship,
indicating that individuals with ADHD are indeed more
likely to not just espouse entrepreneurial intentions, but
also to initiate business venturing. Considering the design,
it suggests a self-selection toward entrepreneurship in in-
dividuals with ADHD (before potentially being a choice of
last resort).
Keywords Attention deficit/hyperactivity disorder .
ADHD .Nascent venturing .Entrepreneurial intentions .
Entrepreneurial action .Entrepreneurship
JEL Classification L26
1 Introduction
By the end of the twentieth century, the entrepreneurship
literature had built a body of knowledge on logical,
generally positive, factors associated with business ven-
turing such as human capital, financial capital, cognitive
biases, and traditionaltraits differentiating entrepreneurs
(Shane 2003). Building on that tradition, in the twenty-
first century, scholars have made great strides in advanc-
ing entrepreneurship theory—covering many other
Small Bus Econ (2019) 53:381–392
https://doi.org/10.1007/s11187-018-0061-1
D. A. Lerner
Deusto Business School, Bilbao, Bizkaia, Spain
e-mail: daniel.lerner@colorado.edu
D. A. Lerner
Universidad del Desarrollo, Santiago, Chile
I. Verheul (*)
Department of Strategic Management & Entrepreneurship,
Rotterdam School of Management, Erasmus University
Rotterdam, Rotterdam, The Netherlands
e-mail: iverheul@rsm.nl
R. Thurik
Department of Applied Economics, Erasmus School of
Economics, Erasmus University Rotterdam, Rotterdam,
The Netherlands
e-mail: thurik@ese.eur.nl
R. Thurik
Montpellier Business School (Labex Entrepreneurship),
Montpellier, France
R. Thurik
Erasmus University Rotterdam Institute for Behavior and Biology
(EURIBEB), Rotterdam, The Netherlands
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
factors associated with venturing such as regulatory-
focus (Tumasjan and Braun 2012; Hmieleski and
Baron 2008), affect and passion (Baron et al. 2012;
Cardon et al. 2012; Gielnik et al. 2017). Recently, a
relatively new and growing conversation has
emerged—that involving conventionally dark or pathol-
ogized constructs that may be positively associated with
entrepreneurship. Among the most prominent, and pre-
viously suggested in the popular press (Archer 2014;
The Economist 2012), is attention deficit/hyperactivity
disorder (ADHD).Characterized by disinhibition,
ADHD is indicated by impulsivity, hyperactivity, and
problems with attentional regulation (APA 2013).
The theoretical and practical relevance of the above
to entrepreneurship has recently been discussed
(Verheul et al. 2015,2016;Thuriketal.2016;
Wiklund et al. 2016,2017,2018;Lerner2016; Lerner
et al. 2018a,b,c; Miller and Le Brenton-Miller 2016). In
particular, a number of studies drawing on the ADHD
literature have emerged, suggesting a positive associa-
tion between ADHD-related behavior and entrepre-
neurship, including an increased likelihood of entre-
preneurial intentions (Verheul et al. 2015), venturing
(Verheul et al. 2016), and entrepreneurial orientation
(Thurik et al. 2016). These and related studies provide
an important basis for the present investigation. In
essence, they deal with behavioral tendencies that at
the high end of the spectrum might be indicative of
ADHD or of other disorders. With limited exception
(discussed later), recent empirical research, while
grounded in the clinical construct and literature of
attention deficit/hyperactivity disorder,hasyettoem-
pirically examine ADHD—a diagnosed clinical condi-
tion. In other words, while predicated on prior research
on the (clinical) condition of ADHD, the emerging
entrepreneurship research has yet to examine whether
the condition of ADHD is significantly linked to a
higher propensity for entrepreneurial intentions and
action.Wecontributetorecenttheoryaboutapositive
ADHD—entrepreneurship link by providing a simple
theoretically—empirically aligned test of the connection
between ADHD and entrepreneurship.
The present work offers a number of contributions. It
foments the emergent scholarly interest in the link be-
tween mental conditions and entrepreneurship
(e.g., Wiklund et al. 2018) by focusing on a common
condition that affects millions of adults worldwide (de
Graaf et al. 2008), and that may be over-represented in
entrepreneurial environments. With the overarching aim
of testing whether ADHD is indeed linked to entrepre-
neurship, we go beyond recent research relating behav-
ior that might be indicative of ADHD to entrepreneur-
ship (Lerner 2016; Verheul et al. 2015,2016; Thurik
et al. 2016; Wiklund et al. 2017). Based on the reported
large-scale study involving attention deficit/
hyperactivity disorder, we test whether ADHD is linked
to an increased propensity for both entrepreneurial in-
tentions and action. Grounding the aforementioned, and
in conjunction with related entrepreneurship research
(e.g., Lerner et al. 2018a,c), this work offers a novel
basis for entrepreneurship theory, future research, and
practice.
2 Attention deficit/hyperactivity disorder
2.1 ADHD—the condition
Attention deficit/hyperactivity disorder is a common
clinical condition, defined by impulsive, hyperactive,
and inattentive behavior (APA 2013), affecting individ-
uals of all ages worldwide. With a full discussion of
clinical diagnostic criteria beyond the scope of this
paper, for ADHD to exist, the impulsive, hyperactive,
and inattentive behavior must be pervasive, enduring,
and—to an age inappropriate frequency and magni-
tude—materially impairing normal functioning (APA
2013). Adult ADHD is well-established in scientific
literature (Barkley et al. 2008; Kessler et al. 2005,
2007) and is known to affect organizations and voca-
tional behavior (Bozionelos and Bozionelos 2013;de
Graaf et al. 2008; Halbesleben et al. 2013; Kessler et al.
2009).
Like other disorders, ADHD is diagnosed by a li-
censed clinician (such as a clinical psychologist or psy-
chiatrist), based on a battery of psychological tests and
other data. It also requires differential diagnosis,mean-
ing that the clinician must judge that the behavior and
impairment consistent with ADHD is not attributable to
another condition or cause (e.g., mania, substance
abuse, or say distractibility and impulsivity due to other
reasons such as stress, a lack of sleep, or being in the
midst of a difficult divorce). Suffice to say, there is no
single test, let alone any simple psychometric measure,
able to determine if an individual has ADHD.
ADHD is, by definition, a clinical construct and
disorder, rooted in extensive clinical literature, which
over the past 30+ years has established the validity
382 D. A. Lerner et al.
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condition (APA 2013; Goldman et al. 1998) and the vast
majority of its effects. Consistent with traditional clini-
cal psychology and psychiatry, in the clinical literature,
ADHD is considered inherently pathological.
2.2 ADHD in organizational scholarship
In terms of the emerging management and entrepreneur-
ship literature involving ADHD, recent studies have
relaxed the need to empirically consider the actual con-
dition of ADHD (i.e., individuals with the disorder) and
instead have taken a disposition-type approach (with
two exceptions subsequently elaborated). There are
good and pragmatic reasons for this. The non-clinical
consideration of a clinical construct has allowed empir-
ically tractable investigations and uncovered significant,
non-obvious findings, such as the positive association
between ADHD-type behavior and entrepreneurship.
There are two noteworthy exceptions. First, the re-
cent study of Wiklund, Patzelt, and Dimov (2016)illus-
trates and provides insight into how 14 Swedish entre-
preneurs with ADHD Bbehave.^Their findings demon-
strate the entrepreneurial relevance of having ADHD. In
line with its qualitative design and contribution, the
study cannot speak to—but further motivates—the need
to understand whether there is a significant positive
connection between ADHD and entrepreneurship,
starting with whether ADHD significantly increases
the likelihood of venturing. The second (partial) excep-
tion comes from Verheul et al. (2016) linking individ-
uals’continuous scores on an ADHD screener (the
ASRS v1.1) to their self-employment status in two
datasets. Specifically, Verheul et al. (2016)performed
a sensitivity analysis where individuals were screened
positive or negative for ADHD based on their ASRS
score. Linking the dichotomous screening variable to
self-employment, the authors found the positive associ-
ation between ADHD (type behavior) and self-
employment held.
For organizational research involving ADHD to ad-
vance, however, there is an issue. While empirically not
studying the condition of ADHD, extant entrepreneurship
research imported ADHD from the clinical literature, in-
cluding a short screening tool
1
for identifying individuals
for possible clinical referral/evaluation. We appreciate that
this can be entirely appropriate, depending on the research
question, the state of (incipient) knowledge, and the re-
search constraints. The present concern and hitherto limi-
tation is the absence of a large-scale basis to consider
whether the reported connection with entrepreneurship is
true if considering attention deficit/hyperactivity disorder.
Thus, the unresolved issue with the extant theory and
research, suggesting a positive ADHD—entrepreneurship
link, is that it has been built on and is fundamentally
grounded in, the clinical literature involving a clinical
construct and using a screening tool for the condition of
ADHD, without yet comparing individuals with the con-
dition and those without.
Toward building a sound literature, we need to un-
derstand if the recently suggested positive connection
between ADHD and entrepreneurship is veridical when
considering the condition of ADHD, i.e.,
operationalizing it consistent with its definition as a
diagnosed condition/disorder. Based on the empirical
and theoretical origins of ADHD, finding a positive link
between the diagnosed condition and entrepreneurship
would substantially bolster the emerging conversation.
Specifically, this would validate recent entrepreneurship
theory and findings which, despite involving clinical
literature, have not tested or found a significant link
between attention deficit/hyperactivity disorder and en-
trepreneurship. Thus, extending recent research that has
examined a behavioral disposition that at one end of the
spectrum might be indicative of ADHD (Lerner 2016;
Thurik et al. 2016; Verheul et al. 2015,2016; Wiklund
et al. 2017), true to the grounding literature and ADHD
construct, we focus on the clinical condition of ADHD.
2.3 ADHD and entrepreneurial intentions
Entrepreneurial intentions, typically defined as the ex-
tent to which an individual espouses intentions to form a
venture/become an entrepreneur, has long been a topic
of interest to entrepreneurship scholars (Krueger et al.
2000; Krueger and Brazeal 1994; Kolvereid 1996;
Douglas and Shepherd 2002). Notwithstanding our ul-
timate interest in entrepreneurial action (versus inten-
tion), an important starting point for the scholarly con-
sideration of a connection between ADHD and entre-
preneurship is provided by Verheul et al. (2015). As the
first large-scale scientific inquiry focusing on the topic,
sampling of over 13,000 university students, Verheul
1
Unlike self-report psychometric scales commonly used in manage-
ment research to measure latent non-clinical constructs, the ASRS
(Kessler et al. 2005,2007) was designed and validated to simply screen
individuals for subsequent in-person evaluation by practicing
clinicians.
Entrepreneurship and attention deficit/hyperactivity disorder: a large-scale study involving the clinical... 383
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et al. (2015) link a continuous indicator of ADHD-like
behavior to entrepreneurial career intentions.
We begin by first asking if the apparent ADHD—
entrepreneurial intentions link indeed exists when con-
sidering the clinical condition. It is hitherto unclear
whether, within a normal professional-oriented adult
population, those who have ADHD show significantly
higher entrepreneurial intentions than those without this
condition. Potentially validating and extending prior
research, we will empirically explore whether:
(1) Individuals with attention deficit/hyperactivity dis-
order (a diagnosed condition) have higher entre-
preneurial intentions than those without the
condition.
2.4 ADHD and venturing/entrepreneurial action
Individual entrepreneurial action is central to entrepre-
neurship; without such, Bthere would simply be no
entrepreneurship and no new ventures^(Baron 2007,
p. 167). In regard to business venturing, entrepreneurial
action is often defined by nascent entrepreneurial be-
havior, i.e., actions associated with business start-up
such as opportunity development, making a prototype,
and attempting to acquire start-up resources (Gartner,
Carter, and Reynolds 2004;Reynoldsetal.2004). As
there are myriad potential start-up behaviors, a straight-
forward indicator of whether entrepreneurial action has
commenced is whether an individual is in the process of
attempting to start or is already running a venture (e.g.,
Reynolds et al. 2004).
Considering ADHD as a clinical condition affecting
individual behavior, we acknowledge that it could have
opposing effects on one’s propensity to undertake entre-
preneurial action (i.e., to venture). Although entrepre-
neurship is generally perceived to involve risky, com-
plex, and innovative activities (something typically at-
tractive to individuals with ADHD), the reality of
starting a business may be far less exciting or motivat-
ing. In particular, starting a firm involves many tasks
that are formal, protracted, administrative, and require
attention to mundane detail (e.g., Lerner et al. 2018b).
Individuals with ADHD tend to struggle with such
activities and also perceive them as less attractive
(Barkley 1997). Thus, when it comes to starting a ven-
ture and associated activities requiring sustained atten-
tion to details, individuals with ADHD may be apt to
procrastinate such action or be otherwise distracted by
more stimulating activities (including thinking about
other opportunities/venture ideas). Following this line
of reasoning, the classical pathological perspective on
ADHD would suggest that individuals with ADHD may
be less likely to venture, compared to individuals with-
out ADHD.
Alternatively, considering that entrepreneurship re-
quires an action orientation (Frese 2009; Sarasvathy
2001) and given that unfettered (even impulsive)
action is central to ADHD (APA 2013), the opposite
may be true. In individuals with ADHD Bact first,
think later^behavior prevails, meaning action itself
is often pre-potent (i.e., will be expressed in the
absence of top-down restraint) (Barkley 1997). This
suggests that, at least for experimenting with entre-
preneurship, those with ADHD may very well act
without much or any forethought or consideration of
potential consequences. In this respect, ADHD’sdis-
inhibition (Barkley 1997;Lerner2016)promotes
action. Consistent with this, Wiklund et al. (2016)
document considerable entrepreneurial activity in
their study of 14 entrepreneurs with ADHD.
Likewise, in their sensitivity analysis, Verheul et al.
(2016) find a positive link between a dichotomized
score on the ASRS v1.1 screener and self-employ-
ment. Though the latter can be considered stricter
than using continuous ASRS scores, the ADHD
diagnostic status was entirely unknown. That is, a
positive dichotomous score does not mean an indi-
vidual has ADHD, but rather signifies that further
evaluation by a clinician may be appropriate. Hence,
neither the recent extant studies nor the extensive
popular press provides conclusive empirical evidence
of the central question whether ADHD increases (or
decreases) the probability of venturing/entrepreneurial
action.
Appreciating the ambivalent nature of ADHD
(Lerner et al. 2018b), we note that early-stage venturing
primarily involves initiating entrepreneurial action.
Consequently, we offer but at the same time question
the notion that individuals with ADHD—a clinical dis-
order—are more likely than others to venture. We will
empirically examine whether:
(2) Individuals with attention deficit/hyperactivity
disorder (a diagnosed condition) are more
likely to venture/engage in entrepreneurial ac-
tion than those without the condition.
384 D. A. Lerner et al.
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3Method
To examine whether the positive ADHD–entrepreneur-
ship connection suggested by recent studies is in fact
true when taking into account the clinical disorder, a
large-scale study was undertaken. The purpose was to
provide a basic straightforward examination of the con-
nection between the condition of ADHD (independent
variable) and entrepreneurial intentions (dependent var-
iable 1) as well as entrepreneurial action/venturing (de-
pendent variable 2). We were not interested in full-time
entrepreneurs or employees—but rather focused on a
population that is heterogeneous in terms of venturing
activity (distinguishing between nascent actors and non-
actors) as well as career intentions (distinguishing be-
tween individuals with and without intentions).
Accordingly, and following Verheul et al. (2015), we
sampled about 9800 university students who participat-
ed in GUESSS Netherlands 2014. Comparing the Dutch
sample with the global GUESSS sample, reported in
Sieger et al. (2014), our sample was representative in
terms of age, gender, management students, and the
prevalence of self-employed parents.
2
In relation to the research question, this sample is not
intended to proxy some other population such as entrepre-
neurs, and offers a number of advantages. Given the nature
of the sample and age of the respondents, the inquiry offers
the advantage of capturing individuals prior to the possi-
bility of being forced into entrepreneurship, and prior to
selection and sampling biases that would be present in
older workers. On a related note, it is important to ac-
knowledge that individuals with ADHD are less likely to
attend university (Barkley et al. 2008) and may be pushed
into entrepreneurship via struggles with conventional em-
ployment (Parker, 2018, chapters 2 and 5). Thus, if signif-
icant results positively linking ADHD to entrepreneurship
are found, they may understate what would be the effect in
the general population. Hence, with the research question
about whether in fact the condition of ADHD is linked to
an increased entrepreneurial propensity (and not about
providing a specific parameter estimate of a well-
established effect generalizable to the overall population
or providing insight into mechanisms underlying a link),
the sample likely offers a conservative test of the funda-
mental relationship in question.
The data collection included the following variables:
attention deficit/hyperactivity disorder—yes/no to
whether the individual had the diagnosed condition of
ADHD
3
;entrepreneurial intentions based on Linan and
Chen (2009) and for robustness and replication also
operationalized dichotomously with post-secondary ca-
reer intention (Verheul et al. 2015); venturing/entrepre-
neurial action, operationalized as whether the individual
was in the process of starting or already running a
venture; and covariate/control variables (gender, age,
self-employed parents, academic performance, manage-
ment as field of study). The latter were included based
on their consistency with prior entrepreneurship re-
search (Verheul et al. 2015;Parker,2018,chapters2
and 5).
In terms of ADHD, 4.2% (n=411) reported having
the diagnosed condition. This is comparable to the adult
ADHD community prevalence rate of 5% in the
Netherlands (de Graaf et al. 2008) and more broadly to
the 3.4% across 10 countries according to World Health
Organization studies (de Graaf et al. 2008). That said,
the following issues may arise when collecting the data.
First, there is the possibility of under-reporting:Some
individuals with ADHD may falsely report that they do
not have the condition, for example because they fear
stigmatization. Such false-negatives would reduce an
already very minor base rate and add noise to the em-
pirical testing—increasing the likelihood of null effects
(and type-II error), and decreasing the likelihood of
significant results. Second, in terms of possible over-
reporting, there was no reason for undiagnosed individ-
uals to falsely report an ADHD diagnosis in the data
collection. Also, the rate of 4.2% does not suggest an
over-reporting problem. Third, undiagnosed individuals
2
The Global University Entrepreneurial Spirit Students’Survey
(GUESSS) is a dataset collected by an international research consor-
tium examining career aspirations of students in higher education. For
more information, refer to www.guesssurvey.org.
3
ADHD is not seen or diagnosed as a temporary condition; it is
associated with genetics and enduring neurological differences (phys-
ical brain-structure and neurotransmitters). Individuals previously di-
agnosed that may no longer meet diagnostic criteria, whether per taking
medication or for other reasons, are often considered in-remission.In
relation to the current research, attempting to separate ADHD-
diagnosed individuals fully meeting diagnostic criteria at the time of
data collection and those not meeting full diagnostic criteria at that
moment was neither realistic (as it would require n= 411 individual
clinical evaluations by psychiatrists or clinical psychologists), nor was
it considered essential for our basic research question. Nonetheless,
supplemental analyses are provided examining ADHD-type symptoms
at the time of data collection.
Entrepreneurship and attention deficit/hyperactivity disorder: a large-scale study involving the clinical... 385
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who would qualify for a diagnosis do not lead to spuri-
ous positive results but rather would make any true
positive effect more difficult to detect. Finally, it is
possible that some of the diagnosed individuals take
ADHD medication; the current question however is if
there is a significant link between the ADHD and entre-
preneurship (regardless of whether a diagnosed individ-
ual is medicated). Furthermore, any significant results
would not be an artifact of not controlling for whether a
diagnosed individual was taking medication. Finally, in
relation to possible use of medication, our study is
consistent with the recent studies cited that refrain from
attempting to capture and control for medication use. In
summary, considering the above, any significant find-
ings would likely be conservative in nature.
For straightforward tests of whether ADHD signifi-
cantly increased the likelihood of entrepreneurial inten-
tions and actions, ordinary least squares and logistic
regressions were run—according to the nature of the
dependent variable (continuous or dichotomous, respec-
tively). In addition, we ran ttests examining potential
differences between subgroups.
4Results
The following are the results of the large-scale empirical
inquiry conducted. Table 1presents the descriptive sta-
tistics and correlations.
Tab les 2and 3present the results of the regression
analyses. As Table 2indicates, individuals with an
ADHD diagnosis showed significantly higher entrepre-
neurial intentions. This was the case whether operation-
alized following Linan and Chen (2009) as a continuous
variable, or following Verheul et al.’s(2015) dichoto-
mous variable. In terms ofthe readily interpretable latter,
individuals with ADHD were approximately 1.7 times
(i.e., 60–80%) more likely to have entrepreneurial inten-
tions (models 1c and 1d, odd ratios: 1.8, 1.6). This
extends the findings of Verheul et al. (2015), assuaging
the clinical-but-non-clinical disjuncture of prior research
and validating the veridicality of the previously sug-
gested positive link with intentions.
Even more interestingly, Table 3reveals a significant
positive link between ADHD diagnosis and venturing/
entrepreneurial action. In particular, having ADHD in-
creases the odds of venturing by almost 100%. The results
indicate that university enrolled adults with ADHD are
almost two times more likely to initiate entrepreneurial
action than those without ADHD (models 2a and 2b,
odd ratios: 1.9, 1.8). In other words, among individuals
who still have to make a vocational choice (and have yet
to be pushed into venturing out of necessity/failure in
wage employment), those with the disorder of ADHD
were not less or similarly likely to venture than those
without the disorder, but rather were significantly more
likely to venture. Considering that individuals with
ADHD are less likely to attend post-secondary educa-
tion and may be pushed out of conventional employ-
ment (e.g., Barkley et al. 2008), these results may un-
derstate the true effect size relative to the overall popu-
lation. Considering the design and nature of the sample,
these results do not speak to venturing outcomes, nor
stand to provide generalizable parameter estimates.
Simply, the results provide a straightforward test and
clear support for a positive link between ADHD and
entrepreneurship, attributable to individual choice ver-
sus a vocation of last resort.
These results extend prior research and establish a
potential upside or non-pathological effect of a clinical
disorder. Given the research question, the significant
positive effect of ADHD and the high associated odds
ratios, indicative of a large effect, are the focus.
The low total variance explained rightfully indicates
that there are myriad factors influencing whether an
individual is interested and will engage in venturing.
Moreover, given the representative but minority frequen-
cy of individuals with ADHD diagnoses in the sample,
the overwhelming majority of the sample does not have
ADHD and, accordingly, low R
2
s are not just normal but
mathematically ought to be observed.
4
If around 4% of a
sample has a dichotomous condition, and many individuals
without the disorder also venture, looking at R
2
is analo-
gous to, for example, examining how much of the total
probability of engaging in Corporate Acquisition activity is
explained by a relatively uncommon predictor such as
CEO ADHD. However, the research objective is not
about explaining the broad preponderance of the depen-
dent variable, but instead is about understanding whether a
theoretically meaningful, yet relatively low base rate,
4
Low R
2
s are to be expected based on very limited variance in ADHD
as a dichotomous predictor, especially when attempting to predict a
relatively infrequent dichotomous variable. Any relatively minority
(i.e., low base rate) feature, whether a clinical condition or otherwise,
will not explain the vast preponderance of variance in a human activity
such as entreprene urship—considering such (as a dependent variable)
is also engaged in by some of the overwhelming majority—that is,
those without the low-frequency dichotomous feature.
386 D. A. Lerner et al.
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Tabl e 1 Descriptive statistics and correlations
Mean SD Min. Max. 1 2 3 4 5 6 7 8
1. ADHD diagnosis .04 .20 0 1
2. Self-employed parent(s) .31 .46 0 1 .02
3. Academic performance 4.92 .93 1 7 −.04 .02
4. Management study .21 .41 0 1 −.01 .06 .02
5. Age 22.40 3.39 17 40 .04 −.06 .03 −.05
6. Gender (male = 1) .38 .49 0 1 .04 −.01 -.005 .09 .08
7. Entrepreneurial intentions (dichotomous) .05 .21 0 1 .03 .03 .000 .03 .05 .09
8. Entrepreneurial intentions (continuous) 3.28 1.76 1 7 .03 .14 .005 .18 −.03 .16 .25
9. Venturing/Entrepreneurial action .13 .33 0 1 .05 .08 .03 .06 .05 .18 .43 .37
N= 9749; All correlations ≥|.02| are significant at 5%. All correlations ≥|.03| are significant at 1%
Dichotomous variables are dummy coded (0 = no, 1 = yes)
Tabl e 2 Explaining entrepreneurial intentions (OLS and logistic regression results)
Dependent variable Entrepreneurial Intentions
Continuous DV (Linan and Chen 2009) Dichotomous DV (Verheul et al. 2015)
Model
1a (main-effect) 1b (with controls) 1c (main-effect) 1d (with controls)
Predictor variables B Estimates
(standard errors)
Odds ratios: Exp (B)
(95% confidence interval)
Constant 3.268*** 3.109*** 0.048*** 0.009***
(0.019) (0.152)
Age −0.015* 1.053***
(0.005) (1. 028–1.078)
Gender (male = 1) 0.536*** 2.151***
(0.037) (1. 778–2.602)
Self-employed parent(s) 0.495*** 1.429***
(0.039) (1. 177–1.736)
Academic performance 0.001 0.998
(0.019) (0. 904–1.101)
Management study 0.688*** 1.322**
(0.044) (1. 068–1.636)
ADHD diagnosis 0.231* 0.200* 1.802** 1.625*
(0.095) (0.092) (1.247–2.605) (1.119–2.360)
Model
R
2
, Nagelkerke R
2
.001* .071*** .003** .036***
F-statistic, Chi-square 5.970* 115.768*** 8.511** 113.849***
−2 Log likelihood 3770.50 3631.53
N9211 9124 9869 9770
Significance levels (2-tailed) are indicated as follows: * = 0.05; ** = 0.01; *** = 0.001. Differences in reported Ns are per missing data from
some subjects (SPSS pairwise exclusion)
Entrepreneurship and attention deficit/hyperactivity disorder: a large-scale study involving the clinical... 387
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predictor indeed has a significant and material effect on
the probability of nascent venturing. As such, the highly
significant readily interpretable odds ratios indicative of
a large effect are informative and meaningful. The re-
sults indicate that not only is the effect of ADHD statis-
tically significant, it also materially increases the odds of
venturing. It increases the likelihood of venturing by
almost 100% (79% with covariates), which is compara-
ble to other well-established predictors of entrepreneur-
ship such as having self-employed parents (model 2b).
Considering the research design and myriad other co-
variates ofpotential interest, the results do not illuminate
causal pathways; rather, the results indicate that further
research into how and why is warranted and apt to be
fruitful.
4.1 Supplemental analyses
Despite the theoretical and empirical evidence of the
enduring nature of ADHD (after diagnosis), particular-
ly in relation to our research question, we nonetheless
ran supplemental analyses. Acknowledging that ADHD
diagnosis occurred prior to the time of data col-
lection, we examine whether the diagnosed indi-
viduals still report to have symptoms by assessing
respondents’scores on impulsivity and mental restless-
ness, both of which are associated with adult ADHD
(Barkley 1997; Weyandt et al. 2003). The abbreviated
scale for impulsivity, supported by Webster and Crysel
(2012), was composed of the most appropriate three
items of the Zuckerman et al.’(1993)longerscale.The
abbreviated scale for mental restlessness was composed
of the four primary items of the internal restlessness
factor/scale (Weyandt et al. 2003). Examining the entire
sample (N= 9869), ADHD-diagnosed individuals en-
dorsed mental restlessness (mean: 4.8 on 7-point scale)
and impulsivity (mean: 4.3 on 7-point scale) and scored
significantly higher on both compared to non-diagnosed
individuals (t
1,449=
10.6 and t
1,443=
12.4, respectively;
equal variances not assumed, p< .001). The results were
similar within the subset of venturers (n=579). Here,
the diagnosed individuals endorsed mental restlessness
(mean: 4.8 on 7-point scale) as well as impulsivity
(mean: 4.6 on 7-point scale) and scored significantly
Tabl e 3 Explaining venturing/
entrepreneurial action (logistic
regression results)
Significance levels (2-tailed) are
indicated as follows: ** = 0.01;
*** = 0.001. Differences in re-
ported Ns are per missing data
from some subjects (SPSS
pairwise exclusion)
Dependent Variable Venturing/Entrepreneurial Action (yes = 1)
Model
2a (main-effect) 2b (with controls)
Predictor variables Odds ratios: Exp (B)
(95% confidence interval)
Constant 0.141*** 0.017***
Age 1.039***
(1.022–1.057)
Gender (male = 1) 2.709***
(2.394–3.066)
Self-employed parent(s) 1.665***
(1.469–1.888)
Academic performance 1.111**
(1.041–1.187)
Management study 1.355***
(1.179–1.558)
ADHD Diagnosis 1.926*** 1.792***
(1.510–2.457)(1.393–2.305)
Model
Nagelkerke R
2
.005*** .077***
Chi-square 24.795*** 412.292***
−2 Log likelihood 7513.90 7037.85
N9869 9770
388 D. A. Lerner et al.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
higher on both than non-diagnosed individuals (t
1,51=
3.1
and t
1,61=
5.5, respectively; equal variances not assumed,
p<.001).
5 Discussion
The present paper extends recent entrepreneurship
research, using a strict conceptualization and mea-
surement of ADHD, that is, ADHD as a clinically
diagnosed condition. We find that, in spite of
ADHD’s downsides and individuals having suffi-
cient disorder as to be clinically diagnosed,
ADHD positively rather than negatively affects
the likelihood of venturing. Building on prior re-
search, this elucidates that a dark and pathologized
condition can serve as a wellspring for entrepre-
neurial action. Certainly, future research is needed,
examining entrepreneurial action at a much more
granular level, and the eventual outcomes of such
action beyond the nascent stage (Lerner et al.
2018b). Nonetheless, without entrepreneurial action
Bthere would simply be no entrepreneurship and
no new ventures^(Baron 2007, p. 167). Furthermore,
given the myriad unproductive and destructive behav-
iors also linked to ADHD, entrepreneurial action may be
a constructive outlet regardless of whether a venture is
ultimately founded and successful. Finally, understand-
ing whether there is scientific evidence of a positive link
between the clinical condition of ADHD and initiating
entrepreneurship provides a basis for embarking on
research attempting to capture more complex dynamics
and outcomes.
This complements the qualitative findings of
Wiklund et al. (2016), as well as Verheul et al.’s
(2016) quantitative findings based on dichotomized
ASRS v1.1 scoring. Based on our large-scale
quantitative testing that did not preselect on either
ADHD status or observable entrepreneurs, and pri-
or to the possibility of entrepreneurship as last
resort, we find evidence that individuals diagnosed
with ADHD are more likely to take entrepreneurial
action than individuals without such a diagnosis. It
suggests the potential adaptiveness of the unequiv-
ocally pathological—going beyond behavioral traits
such as impulsivity to a full-blown clinical disor-
der/diagnosis. Our findings empirically advance
emergent theory involving ADHD and clinical
conditions in general, and are in line with recent
research suggesting alternative logics for entrepre-
neurial action (Lerner et al. 2018a).
5.1 Cautions and limitations
It is important to underscore that entrepreneurial
action and performance are not synonymous. The
linkage found between ADHD and venturing/
entrepreneurial action should not be conflated,
nor interpreted as a positive link with venture
performance. The present study cannot speak to
the effect of ADHD on venture performance or
other entrepreneurial outcomes. Rather, it suggests
the need and opportunity for future research in this
direction. Since potential venturing outcomes in-
clude everything from success to catastrophic loss
(with negative outcomes more likely if inattentive
to foreseeable pitfalls or if impulsively spending
through savings, high-interest debt, or home equi-
ty), future research is needed to more fully under-
stand the connection between ADHD and ventur-
ing, including if entrepreneurship is on average a
good fit for individuals with ADHD. Suffice to
say, the connection between ADHD and later
stages of organizing, profitability, and growth are
yet unknown—anditisunlikelytobeentirelyrosy
or dark (Lerner et al. 2018b).
Our study has several limitations. The simple,
straightforward design and sample used were ap-
propriate for the critical research question of
whether actual ADHD and the likelihood of entre-
preneurial action are positively connected. The re-
sultant coefficient estimates, while likely conserva-
tive in nature for aforementioned reasons, should
however not be presumed to be broadly generaliz-
able to other populations (Antshel 2017;Canits
et al. 2018). At an even deeper level, it is impor-
tant to recall that generalizability is not per se a
property of any empirical study, but rather is a
question of whether a theoretical relationship gen-
eralizes across empirical contexts (Zelditch 1969).
As our findings quite strongly ground prior re-
search and establish the central theorized relation-
ship, they indicate the fruitfulness of future re-
search involving other populations, other designs,
and more complex theory.
Entrepreneurship and attention deficit/hyperactivity disorder: a large-scale study involving the clinical... 389
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
5.2 Implications and conclusions
The present work foments and contributes to various
scholarly conversations, particularly those involving
mental health or ADHD and entrepreneurship
(Lerner 2016;Lerneretal.2018b; Thurik et al.
2016; Verheul et al. 2015,2016; Wiklund et al.
2016). It also serves as a basis for future research.
For example, the finding that individuals with
ADHD are almost two times more likely to venture
indicates the merit of further studies on ADHD and
venturing outcomes. This is particularly so once
considering the otherwise squandered human capi-
tal, the costs of business failure, and/or the many
adverse outcomes associated with unchanneled adult
ADHD (such as absenteeism, unemployment, sub-
stance abuse, incarceration).
Bolstered by the findings of our large-scale
quantitative inquiry, ADHD has implications for
organizational research, practice, and policy.
Research implications include highlighting the
need for further study of contextual factors deter-
mining under which conditions ADHD is a
strength or a weakness, and is adaptive or
counter-productive in venturing. In regard to prac-
tice and policy, understanding that mental health,
and ADHD in particular, has dark and bright sides
for entrepreneurship, has various implications. For
example, it suggests the opportunity for research to
help educators, clinicians, and even organizations
focus on strengths (such as a willingness to act, an
imperturbable focus on activities of interest) and
compensate for weaknesses (such as distractibility
and poor attention to detail in mundane activities).
More generally, it suggests the continued opportu-
nity for considering other predictors potentially
seen as aberrant in respect to entrepreneurship
(e.g., Hmieleski and Lerner 2016; Wiklund et al.
2018).
Overall, the present work contributes to theory
by grounding recent research linking ADHD and
entrepreneurship with a large-scale quantitative ex-
amination that squarely tests the effect of attention
deficit/hyperactivity disorder. In concert with other
studies, the work establishes an emergent entrepre-
neurship literature on ADHD. In doing so, it at-
tests to broader emerging theory that generally
suggests the relevance of clinical or otherwise
dark constructs in entrepreneurship.
Open Access This article is distributed under the terms of the
Creative Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/), which permits unrestrict-
ed use, distribution, and reproduction in any medium, provided
you give appropriate credit to theoriginal author(s) and the source,
provide a link to the Creative Commons license, and indicate if
changes were made.
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