Executive function difficulties are common in people with attention deficit hyperactivity disorder (ADHD). Executive function refers to the cognitive abilities necessary to plan and achieve goals, solve problems, and regulate emotions.
Executive function allows people to self-regulate, plan for short- and long-term results of their actions, and make necessary adjustments to meet goals.
Working memory and self-control usually develop first during early childhood. Planning, following goals, and problem-solving abilities increase throughout adolescence, while improved decision-making and problem-solving develop in adulthood.
According to the charity Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), some people with ADHD may experience difficulties with some parts of executive function.
This article will explore this link further, including symptoms of executive dysfunction, ways to improve these abilities, and when to speak with a doctor.
CHADD highlights four main areas of executive function:
- nonverbal working memory
- verbal working memory
- self-regulation of motivation, affect, or arousal
- planning and creating
People with ADHD may have difficulties with some executive functions. This includes the ability to self-regulate, which can cause impulsive reactions.
Executive functions can break down further into the following:
- organizing, prioritizing, and starting tasks
- focusing, shifting attention to, and sustaining a task
- sustaining effort and processing speed, and regulating alertness
- managing emotions and frustration
- using working memory and recall
- self-monitoring and self-regulating action
People with ADHD may experience difficulties in some of these areas, leading to attention deficits and problems starting and completing tasks.
Symptoms of executive dysfunction may include trouble with:
- organizing tasks
- getting started with a task
- staying engaged and alert
- keeping a level emotional state
- using working memory and recall
- avoiding tasks that require sustained attention
People with executive function issues may get easily overwhelmed, take much longer to carry out routine tasks, or leave assignments until right before a deadline.
Making certain adjustments may help people to manage executive function issues. CHADD suggests the following tips for helping children with ADHD to manage executive dysfunction:
- using a checklist to tick off tasks or smaller steps toward a goal
- creating an agenda that details how to submit work
- using clearly labeled folders or notebooks for different subjects or work areas
- imagine or visualize the necessary steps to complete a task, including when, where, and how to meet the deadline
- create systems, such as using sticky notes as reminders, to help stay on track with tasks
People with executive dysfunction issues may also benefit from using a whiteboard to list all activities and to use as a schedule.
The Child Mind Institute suggests:
- using a planner to write down all tasks and deadlines
- establishing a routine for getting tasks done
- creating a quiet environment with no distractions to work in
- creating checklists or schedules for activities that prove challenging, such as getting out of the house on time and setting time limits for each step
- using a reward system as motivation, such as a star chart for children, or plenty of encouragement
- planning and preparing for the next day the evening before to help reduce the amount of decision-making
- learning the reason behind organizational strategies may make people more likely to stick to them
- trying out new learning methods, such as visual or tactile methods
These methods may also help adults with ADHD to manage difficulties with executive function.
Other methods to manage executive dysfunction
Medication for ADHD may help improve executive function. Medications that a doctor may prescribe include stimulants, such as Adderall, Ritalin, and Vyvanse, or nonstimulants, such as guanfacine extended release and Strattera.
Cognitive behavioral therapy (CBT) may also help improve executive function. CBT aims to help people replace unhelpful thinking patterns and habits with more positive ones to help people reach their goals.
Other methods to improve executive function may include:
- programs for training working memory
- mindfulness practices for improving focus and attention
- coaching or support to motivate behavior
- developing routine, structure, and organization to help complete a task
If people with ADHD experience difficulties with executive function, they can speak with a doctor.
A doctor may carry out tests to assess how severe a person’s executive dysfunction is and how it is affecting their everyday life. The Attention Deficit Disorder Association (ADDA) states that this may include:
- assessing any symptoms or patterns, such as those around organization, problem-solving, impulsivity, multitasking, and focus
- executive function tests to measure specific skills such as working memory or inhibition control
- for adults, a doctor may use the Barkley Deficits in Executive Functioning Scale to assess executive function over time
The ADDA suggests that, in many cases, treatment and management can improve executive functioning in people with ADHD. This may include organizational strategies, stimulant or nonstimulant medications, or CBT.
CBT may help improve executive functioning, including time organization, time management, and prioritizing tasks.
Issues with executive function can often run alongside symptoms of ADHD. Executive dysfunction can make it difficult for people to organize, prioritize, and meet goals or deadlines. They may also respond impulsively or feel overwhelmed by daily tasks.
Using organizational strategies, planners, and checklists and developing clear structures and routines may help. CBT and ADHD medications may also help improve executive function.