Is ADHD a Disorder of Executive Functioning?

Is ADHD a Disorder of Executive Functioning?

Thought leaders in psychology such as Russell Barkley, Ph.D., and Thomas Brown, Ph.D. have identified ADHD as a disorder of executive functioning. Rather than focusing on the major symptoms of ADHD such as difficulty with sustained attention, not listening, poor organization, forgetfulness in daily activities, restlessness, excessive talking, difficulty awaiting turns, or being fidgety, these experts see executive-functioning deficits as the defining characteristics of ADHD. Interestingly, executive dysfunctions, or difficulty employing executive-functioning skills, are also telltale features of many other psychiatric diagnoses in children. For example, beyond ADHD, children who have learning disabilities display an array of executive dysfunctions that underlie many of their academic struggles.

Technically speaking, the Diagnostic and Statistical Manual-V (DSM-V), which lists all current psychiatric disorders, does not directly incorporate executive dysfunctions into formal psychiatric diagnoses but describes many of these executive skills as features of common psychiatric issues. And while not a formal part of the diagnosis, identifying an executive dysfunction is very helpful in developing educational and psychological interventions for individuals.

It is common for those who do not have a formal psychiatric diagnosis to experience difficulty with one or more executive functions. For example, kids and teens might describe themselves as struggling with organization skills or having difficulty regulating their anger. However, moderate difficulty with executive functions does not warrant a psychiatric diagnosis. Problems with executive functions such as planning, working memory, and time management in the classroom can lead to lowered academic performance. When youngsters display many executive dysfunctions, consideration of a formal diagnosis and obtaining a neuropsychological evaluation may be appropriate.

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  • The following list describes the executive dysfunctions most frequently seen in kids who are both formally diagnosed or who show symptoms of common childhood disorders. Use this list to identify skills that may be interfering with children working to their potential. As you do so, use our resources at LearningWorks for Kids and South County Child and Family Consultants to develop strategies to address these executive dysfunctions.

    ADHD or Attention Disorders

    • Sustained attention — has difficulty attending in the presence of distractions and sustaining attention and effort levels while engaged in tasks
    • Working memory — has difficulty following multi-step directions and remembering what has read
    • Response inhibition — has difficulty thinking before acting
    • Time management — may waste time or rush through tasks, thus executing them inefficiently and ineffectively
    • Task initiation — has difficulty knowing how to get started on a task and sustaining the attention and effort levels needed to complete it
    • Planning — has difficulty identifying and employing strategies and systematic approaches to reach a goal
    • Working memory — has difficulty keeping things in mind and controlling attention while engaged in an activity
    • Organization — has difficulty organizing objects, ideas, and possessions
    • Flexibility — has a tendency to be rigid and not learn from mistakes
    • Regulation of affect — struggles to manage feelings, actions, and frustrations
    • Time management — lacks efficiency in starting and completing tasks
    • Social thinking — has difficulty understanding his motivations and the thoughts and feelings of others

    Autism Spectrum Disorder of Social Skills Deficits

    Impaired executive skills:

    • Social thinking — struggles to understand social cues and lacks social-communication skills
    • Flexibility — may be rigid with regard to his her interests and struggles with changing routines
    • Planning — may have difficulty thinking about all the different sides of a situation or determining where to devote his energy and effort
    • Regulation of affect — struggles to manage feelings, actions, and frustrations
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  • Specific Learning Disabilities or Dyslexia

    • Working memory — may struggle to keep phonemes (letter sounds) in mind when decoding/sounding out words
    • Working memory — may struggle to keep in mind the meaning of previous sentences in order to attain/enhance reading comprehension
    • Organization — may struggle to keep ideas in mind to understand a paragraph, story, or book
    • Time management — may struggle with fluency and pace while reading, causing comprehension difficulties and other issues
    • Sustained attention — may have difficulty sustaining the attention and effort levels necessary to support the constant practice struggling readers require
    • Task persistence — may struggle to sustain the attention and effort levels necessary to complete tasks that are difficult for him
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