ADHD is a neurodevelopmental disorder that is characterized by hyperactivity, distractibility, and impulsivity. According to one theory, ADHD is caused by problems with executive functioning. Executive dysfunction leads to deficiency in organization, memory, recall, and self-regulation.

Executive functions grow and change over time. However, people with ADHD are 30 to 40% behind in transitioning from one executive function to the next.

So, how does executive dysfunction manifest in ADHD? This article will discuss how they’re connected and treatment options to consider to address executive dysfunction in ADHD.

🔑 Key Takeaways

Individuals with ADHD often lag 30 - 40% behind their peers in transitioning between stages of executive functioning.
Executive dysfunction involves having difficulty using executive functions, including self-awareness, inhibition, verbal and nonverbal working memory, emotional and motivational regulation, planning, and problem-solving.
There are six areas of executive dysfunction in ADHD: focus, activation, emotion, memory, effort, and action.
Possible causes of executive dysfunction in ADHD are heredity, structural abnormalities, and deficits in dopamine signaling mechanisms.
Executive dysfunction in ADHD can be evaluated and diagnosed through the use of scales like Conners 3, BRIEF, BDEFS, and CEFI.
Treatment options and strategies include cognitive behavioral therapy, psychostimulant medications, and executive function training programs.
There are training programs that offer exercises that improve executive functioning. Examples of these programs are CogniFit, BrainWare SAFARI, and NeuroTracker.

What is Executive Dysfunction?

Executive dysfunction is difficulty in developing or carrying out any of the executive functions. The human brain has seven different executive functions, which are the following

Self-awareness: This is also known as self-directed attention or an individual’s awareness of what they are doing.
Inhibition: This is the ability to control impulses and practice self-restraint.
Verbal working memory: This is the ability to preserve a limited amount of speech-related information. It is also known as one’s “inner monologue.”.
Nonverbal working memory: This is the ability to conduct visual imagery or hold things in the mind. Nonverbal working memory focuses on self-directed sensing and guides behavior through anticipation and memory.
Emotional regulation: This is the ability to modulate feelings through using words, images, and self-awareness to process and express how an individual feels about certain things and events.
Motivational regulation: This is the ability to motivate oneself when accomplishing tasks despite no external consequence and not needing guidance from others.
Planning and problem-solving: This is the ability to develop a plan that can be changed, reformulated, and updated through trial and error. It is also called "self-play," as individuals play with information to think of new methods.

Symptoms of Executive Dysfunction

Individuals with executive dysfunction may experience the following challenges:

Time blindness, or being unable to plan and remember upcoming events
Difficulty setting schedules and organizing materials
Unable to control impulses and emotions
Difficulty processing and analyzing information
Difficulty in paying attention
Difficulty in getting started on tasks and switching from one task to another
Trouble with thinking before acting
Forgetfulness and being easily distracted

What Is Executive Dysfunction in ADHD?

A study found six areas of executive dysfunction in those with ADHD. These areas are activation, focus, emotion, effort, memory, and action.

Activation

This area of executive dysfunction involves:

Prioritization and organization of tasks
Estimation of time
Starting on work tasks and activities

Individuals with ADHD struggle with procrastination and delaying tasks until the last minute. They can’t get started on tasks until they consider them urgent.

Focus

This refers to sustaining focus and shifting focus between tasks. Individuals with ADHD are easily distracted by their surroundings and thoughts.

They also experience difficulty in focusing on reading. Words require repeated reading to understand and remember their meaning entirely.

Emotion

This refers to emotion management and modulation.

Individuals with ADHD describe having difficulty managing feelings, such as:

Disappointment
Frustration
Anger
Worry

They find it challenging to put these emotions at the back of their minds and focus on the tasks that must be done.

Effort

This involves factors when finishing tasks like maintaining alertness and level of effort and processing speed.

Those with ADHD can perform short-term tasks well. However, they may struggle to sustain effort over extended periods and complete tasks on time.

Memory

This refers to using working memory and recall.

People with ADHD often have good memory recall for previous events. However, they may struggle with remembering recent events or conversations and retrieving learned information from memory when needed.

Action

This involves the monitoring and regulation of one’s actions.

People with ADHD have difficulty regulating their actions because of their impulsivity, which can manifest in both what they say and do. This impulsivity may lead to jumping to inaccurate conclusions and acting without adequate consideration.

They may also have problems monitoring the context in which they interact. They may fail to recognize when others are confused, hurt, or annoyed by their behavior, which results in missed opportunities to adjust their actions appropriately.

Causes of Executive Dysfunction in ADHD

Executive dysfunction in ADHD may be due to the following factors:

Heredity

Executive dysfunction in ADHD may be due to heredity. This finding is evidenced by research indicating that ADHD has a high heritability rate, with genetics contributing to about 82% of the risk.

Structural Abnormalities

Another study mentioned that structural abnormalities are found in individuals with ADHD, particularly in the caudate nucleus and the frontal cortex, which may affect executive function.

Deficit In Dopamine-Signaling Mechanisms

According to a study, executive dysfunction is attributed to a deficit in dopamine-signaling mechanisms, which is also linked to genetic factors affecting the prefrontal cortex, basal ganglia, thalamus, and amygdala circuits.

Evaluation and Diagnosis of Executive Dysfunction in ADHD

Evaluating and diagnosing executive dysfunction begins with checking for other conditions with similar symptoms. Standard evaluation scales used are discussed in this section.

Behavior Rating Inventory of Executive Function (BRIEF)

Source: PAR

The BRIEF questionnaire measures executive function in children, adolescents, and adults. This scale provides valuable information for therapists, schools, and treatment providers to make informed interventions and recommendations for clients with executive dysfunction.

Conners 3

Source: WPS

The Conners 3 offers a more comprehensive evaluation of ADHD and related learning, behavior, and emotional issues. Empirical scales of Conners 3 include:

Executive Functioning
Hyperactivity/ Impulsivity
Learning Problems
Aggression
Peer Relations
Family Relations

Barkley Deficits in Executive Functioning Scale (BDEFS)

Source: Matthews Books

The BDEFS is a tool for assessing adult executive functioning. This scale provides a more accurate assessment of:

Time management
Problem-solving
Self-restraint
Motivation
Emotion regulation

Comprehensive Executive Function Inventory (CEFI)

Source: WPS

The CEFI is a behavior rating scale for children and adolescents that assesses strengths and weaknesses in executive functioning. It aids in assessment, diagnosis, and intervention. It is also helpful in research settings for measuring the success of intervention programs.

Treatments and Strategies in Managing Executive Dysfunction in ADHD

Several treatment options and management strategies could help improve areas of executive dysfunction for people with ADHD. Such options are cognitive behavioral therapy, psychostimulant medications, and executive function training programs.

Cognitive Behavioral Therapy (CBT)

CBT can enhance executive functioning. This therapy focuses on identifying and changing maladaptive thought and behavior patterns.

A study on students with ADHD showed there were statistically significant improvements in their executive functioning after CBT, particularly in metacognition and behavioral regulation. The same study also found that symptoms of ADHD, anxiety, and depression had significant reductions after the treatment.

💡 Did You Know?

CBT is typically administered in person. However, as choices for remote healthcare grow, therapist-guided remote CBT has emerged. Remote CBT provides more access to individuals without sacrificing the quality of care.

Psychostimulant Medications

Psychostimulant medications are the first line of treatment for ADHD. They block dopamine transporters and boost noradrenaline and dopamine.

Examples of psychostimulant medications for ADHD are:

Methylphenidate
Amphetamine
Dexamphetamine
Lisdexamfetamine

Efficacy of Psychostimulant Medications

These medications are commonly used for treating ADHD in children. They are reported to have 70% effectiveness and well-documented efficacy in improving the following aspects:

Executive and nonexecutive memory
Reaction time
Reaction time variability
Response inhibition

Another study aimed to measure executive function in children with ADHD, whether they’re on medication or not with psychostimulants. Using these medications was associated with better performance in executive function, particularly in:

Short-term memory
Set-shifting ability
Spatial working memory
Planning ability

Executive Function Training Programs

Enrolling in an executive function training program is another strategy for improving executive functioning.

A study exploring a cognitive program for children with ADHD resulted in better executive functioning performance after the intervention. Behavioral problems also reduced significantly, based on parental reports. According to the reports, there was a decrease in children’s problem behaviors while expected behaviors increased.

There are various programs online designed to train and strengthen executive functions. Such programs are CogniFit, BrainWare SAFARI, and NeuroTracker.

CogniFit

Source: CogniFit

CogniFit is a training program designed to rehabilitate, improve, and strengthen executive functions. The training program includes online cognitive stimulation activities that enhance these skills:

Working memory
Processing speed
Planning
Focus

Individuals can access and complete these activities via computer, tablet, or smartphone.

BrainWare SAFARI

Source: BrainWare

BrainWave Learning also offers cognitive training using the BrainWare SAFARI software. This software has the following features:

Works on core executive functions such as cognitive flexibility and working memory
Works on higher-order executive functions
Based on over 40 years of collaboration between different medical fields
Based on field studies and published research
Can be used in various settings

Schedule a discovery call with BrainWave Learning to learn more.

NeuroTracker

Source: CogniFit

Another option to consider is NeuroTracker. This tool has the following features:

“Dual tasking method,” which adds extra exercises while you train
Was shown to improve brain function after 15 to 30 sessions
Allows users to keep track of their progress during the training
Offers a free 6-minute assessment test to check how you compare to other groups

Wrap Up

Executive dysfunction in ADHD often involves impairments in activation, focus, emotion, effort, memory, and action. This condition may be caused by heredity, deficits in dopamine signaling mechanisms, or structural abnormalities in the brain. Health professionals may evaluate individuals with ADHD for executive dysfunction through the use of scales such as BRIEF, Conners 3, BDEFS, and CEFI.

Executive dysfunction in ADHD can be managed and addressed through various options, such as CBT, professional consultations, and training programs on executive function. Through these interventions, individuals with ADHD can strengthen their executive functioning skills and manage related challenges.

FAQs on Executive Dysfunction in ADHD

What other strategies help manage executive dysfunction in ADHD?

Experts suggest redesigning the environment to support executive dysfunction in ADHD. You can use lists, planners, and apps to stay on task. External motivation, such as point systems and daily report cards, can also help.

How do ADHD and executive dysfunction differ from each other?

ADHD is characterized by difficulties in focus, organization, and impulse control. Executive dysfunction refers to broader cognitive weaknesses in skills. Such skills include memory, time management, and attention. Executive dysfunction is experienced by most individuals with ADHD. However, it is possible to have executive function difficulties without an ADHD diagnosis.

Does stress play a role in executive dysfunction?

Yes, stress plays a role in executive dysfunction. A study found that acute stress can impair working memory and cognitive flexibility.

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Jeff Caba, DHSc, PA-C.

Jeff brings to Buoy over 20 years of clinical experience as a physician assistant in urgent care and internal medicine. He also has extensive experience in healthcare administration, most recently as developer and director of an urgent care center. While completing his doctorate in Health Sciences at A.T. Still University, Jeff studied population health, healthcare systems, and evidence-based medi...

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