ADHD & Executive Functioning

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ADHD & Executive Functioning

Attention-deficit/hyperactivity disorder (ADHD) is a biological-based disorder and a developmental impairment of executive functions. Most people with ADHD will experience many areas of executive function impairment, although people without ADHD can have executive dysfunction as well.

Executive functioning disorder (EFD) is a brain-based impairment that causes issues with analyzing, planning, organizing, scheduling, or completing tasks at all. Children and adults with EFD have issues organizing materials, setting schedules, often misplace papers, reports, or school items. Their rooms tend to be unorganized, and they can frequently lose track of personal items.

Many ADHD symptoms point to difficulties with executive functioning (the self-management system of the brain) and may indicate that ADHD is a partial executive functioning disorder. Working memory, cognitive flexibility, and inhibitory control are the three aspects of executive functioning.

Let’s take a closer look at the aspects of executive functioning and their links with ADHD.

Working memory is the conscious awareness center where information is manipulated or transformed. Working memory is used when you recall a mental grocery list and go around the store picking up items and then visualizing crossing them off. Working memory is also involved if your child is asked to complete three tasks: they must plan and prioritize the tasks, execute actions to complete the task, and mentally cross those tasks off the list.

Cognitive flexibility is the ability to apply what has been learned differently depending on the situation, as opposed to rigidly adhering to rules or previous ways of doing things. An adult example would be being forced to deviate from a previously established driving route home. A child might adapt to changing afternoon plans if a sibling becomes ill and needs to be taken to the doctor’s office.

Finally, inhibitory control is the ability to resist impulses to act without thinking. For adults, this could mean ignoring a text message while driving. For children, this can mean using words rather than aggression (biting, hitting, kicking) when disagreeing with peers, or raising one’s hand rather than shouting to answer a teacher’s question in class.

These three critical areas serve as a bridge between self-regulation and attention. However, rather than referring to them as innate abilities (i.e., immutable, unchangeable characteristics of a child), executive functioning may be more usefully viewed as a set of skills that can be learned, augmented, and improved.

According to Dr. Adel C. Najdowski, behavior-based executive functioning treatment targets the following areas:

  • Self-awareness
  • Inhibition and impulse control
  • Self-management
  • Attention
  • Organization
  • Problem solving
  • Time management
  • Planning
  • Working memory
  • Emotional self-regulation
  • Flexibility

In adults and children with ADHD, the following six executive functioning clusters tend to be impaired in these individuals:

  • Activation: organizing tasks, getting started, and estimating time.
  • Focus: finding attention, sustaining attention, and shifting attention as needed.
  • Effort: processing speed, regulating alertness, and sustaining motivation.
  • Emotion: modulating feelings and managing frustrations
  • Memory: accessing recall and using working memory
  • Action: regulating and monitoring physical activity

There are a range of strategies that can be used to help strengthen the areas of weakness associated with ADHD and executive dysfunction. An example is using external motivations such as being accountable to others (at work or school), establishing point or reward systems, or anything that will reinforce accomplishing set goals.

Experts recommend finding a specialist such as a psychologist, speech therapist, or reading tutor that can aid in designing an effective plan to work on areas of dysfunction.