ADHD and the Executive Functions
TLDR; ADHDers struggle with executive dysfunction, which is struggling with the executive functions (EFs) of the brain that help us in different areas of our lives. The core EFs are inhibition (regulating our emotions and behaviour), working memory (remember information to work with it) and cognitive flexibility (thinking flexibly enough so we donāt struggle with change or thinking differently).
Thereās a plethora of symptoms for ADHDers that go beyond the typical inattention, hyperactivity and impulsivity, but theyāre not commonly talked about, like how we struggle with executive dysfunction.
What are the executive functions?
Theyāre a group of mental processes that are essential for us to go through life, these are cognitive skills like planning, prioritising, initiating tasks and motivation. They affect how we manage work, school, our mental and physical health and even how we socialise.
Executive functions (or EFs) can be categorised in two types, organisation and regulatory abilities. The first ones are about gathering and structuring information in our brains, the second is about evaluating that information to make a response to it. This is what makes us look at something we like and think about how much we need it and set a level of priority for it.
Besides these two big categories, there are three core functions; inhibition, working memory and cognitive flexibility.
Inhibitory control is the ability that helps us to control our attention, behaviour, thoughts and emotions in response to an internal or external stimulus so we donāt let our instincts be in charge of everything.
Considering this, we already can see how this core EF is really impaired when it comes to ADHD. After all, the most common struggles and symptoms of it have to do with how we regulate our attention when thereās different distractions near us, our impulsivity and our issues with emotional regulation.
This core EF involves holding information in our brains so we can mentally work with it. This is like when you cook and you have to remember the steps you followed from a recipe so you donāt accidentally go through the same step twice.
Considering the definition of working memory, itās important we differentiate it with short-term memory, which doesnāt manipulate information, just stores it for a short period of time and it isnāt actually hit with ADHD as working memory is.
This is quite a critical skill, because itās thanks to this one that we can make sense of what just happened so we know what to do next with that information. And itās also a skill thatās greatly impaired for us ADHD folk, kinda like when I go grab a pot that was on the stove and burn myself, and then go for it a second time until I finally remember āwait, Iāll go get the oven mittā.
The last core EF is the build up of the first two. This one is about being able to change perspectives spatially and interpersonally, changing how we think about something or thinking outside the box, adjust to priorities or demands that change, admit weāre wrong and even take advantage of sudden opportunities that present to us.
ADHDers are VERY good at being outside the box thinkers, weāre great when thereās a problem that needs a new solution to fix it, weāre fast to take risks and we usually like change. So you may wonder why are we still talking about it? Well, thatās because cognitive flexibility is also involved in task shifting which is a very common problem for ADHDers, if thereās sudden changes to our routines we can abandon them because we just canāt make ourselves go back to it, and some of us do struggle to take opportunities that are good for us.
This EF may not be as clearly impaired as the first two, but that doesnāt mean we donāt struggle with it.
Thereās something a lot of ADHDers are not aware of, including myself until a few years ago. The reason we struggle so much to do something that seems so simple to others, the reason why we can have great days that are so productive only to find it so hard the next day to just send an email and be an adult, thatās because of impaired executive function, which is called executive dysfunction.
As Dr. Russel Barkley usually says, ADHD is not a deficit of attention, but a deficit of executive functions. Not all ADHDers struggle with the same EFs, and not all of us struggle the same way, but there are six clusters of EFs that tend to be impaired in us; activation, focus, effort, emotion, memory and action.
Activation is about organising tasks and the materials we need to do something, estimating time, and actually getting started. Focus is managing our attention as needed during a task, be it sustaining it or shifting it. Effort has to do with regulating alertness, sustaining motivation and processing speed during a task. Emotion and memory are strongly linked to inhibition and working memory, so itās just what you read before. And finally action is about monitoring and regulating physical activity.
Just as not two ADHDers are the same, not two days of one ADHDer will be the same, and this is because executive dysfunction can be linked to dopamine, a neurotransmitter that we donāt produce in the same amount as non-ADHDers. Because of this, EFs are also linked to our interests, which is why itās SO much easier to gather snacks for game night, sustaining focus and motivation to keep on playing while being aware of what our body does to get the special moves, but we canāt do the same when itās about writing that 10 page essay on co-property in law school (yes, I am having war flashbacks).
I am no expert, but I do like to read what experts have to say when it comes to ADHD, and for some problems taking our medicine is all we need, for others the best strategy is working with a psychologist and occupational therapist, or going for Cognitive Behavioural Therapy, commonly known as CBT. Thereās not a one-shoe-fits-all solution even in the professionalsā opinion, especially when thereās comorbidities like depression or anxiety that also impair our EFs.
Besides that, we can always tackle these issues with some external help, like making calendars in a very obvious place so we donāt lose track of time, use organisational apps like Todoist in synch with Google Calendar so we can add tasks fast and have it all synched in our devices. Something that helps a lot is having accountability, talk with someone you trust and tell them about your struggles and your plans, sometimes having someone else to talk to really makes a difference. If you want a lighter method of accountability, you could also try body-doubling, a passive way of accountability.
Hope you enjoyed reading this far! For more information, check the sources, the first one has more in depth strategies. And remember, Iām not a medical professional, I just have ADHD and love to read about it.
- https://www.psychologytoday.com/us/blog/the-best-strategies-managing-adult-adhd/201601/adult-adhd-and-work-improving-executive-function
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084861/
- https://www.additudemag.com/what-is-executive-function-disorder/
- https://memory.ucsf.edu/symptoms/executive-functions
- https://www.sciencedirect.com/science/article/abs/pii/S0165178119310376#
- https://www.additudemag.com/what-is-executive-function-disorder/
- https://vistapineshealth.com/treatment/adhd/impact-memory/