Yes, I’m still on this train. I’m absolutely certain that executive dysfunction is the main issue with ADHD. Since I first wrote about this, I’ve been exploring it all more fully, and I’m having more ideas and so on. So, let’s revisit this concept.
If you do a search for executive dysfunction and ADHD, you’ll get a bunch of stuff about how executive dysfunction is a symptom of ADHD, but not everyone who has executive dysfunction has ADHD. I agree with this: having executive dysfunction doesn’t mean that you have ADHD. However, if you have ADHD you definitely have executive dysfunction.
The problem is that people don’t realize what processes are executive functions, so they don’t see how our executive functions relate to the diagnostic criteria for ADHD. Executive functions are higher-level processes in the brain that let us control our behaviours, our attention, our emotional displays, and so on. The frontal lobe handles this stuff, so if that’s not working the best we’re going to struggle with it. That’s why a lot of people who have a traumatic brain injury struggle with executive functioning, and why so many other brain-specific conditions involve executive functions.
To my mind, ADHD is unique in that every single diagnostic criteria can be tied to at least one executive function.
Inattentive ADHD expects children to show at least six of nine criteria, in multiple settings, for at least six months beginning before the age of 12. Hyperactive/Impulsive ADHD expects at least six of eight criteria, in multiple settings, for at least six months beginning before the age of 12. Combined ADHD expects both six of nine Inattentive criteria and six of eight Hyperactive/Impulsive criteria. For adults, the expectation is five criteria instead of six, but otherwise the same.
There are nine executive functions that I’ve sorted out as of this writing. Eight of these apply to Inattentive ADHD, and four apply to Hyperactive/Impulsive ADHD, while all of them apply to Combined ADHD.
This is why there’s overlap. This is why people who have Inattentive ADHD also have some Hyperactive/Impulsive symptoms, and vice versa.
There are three executive functions that contribute to all three types of ADHD. No matter what type of ADHD you have, you’re probably going to have issues with:
- Cognitive Flexibility;
- Goal-Directed Behaviour; and/or
- Self-Monitoring.
What does this mean? It means that most ADHDers have trouble dealing with sudden changes in their situations or environment (Cognitive Flexibility). It means that most ADHDers struggle with working towards goals, especially if those goals are long-term and progress isn’t something they can see right away (Goal-Directed Behaviour). And it means that most ADHDers are a bit oblivious to how they come across to other people and don’t always realize when their emotions are starting to spike or when they need to eat, use the bathroom, sleep, etc. (Self-Monitoring).
One executive function is specific to Hyperactive/Impulsive ADHD, and that is Inhibitory Control. This means that Hyperactive/Impulsive ADHDers have trouble keeping themselves from doing or saying whatever pops into their head.
The rest of the executive functions are related to Inattentive ADHD. These are:
- Attentional Control;
- Cognitive Inhibition;
- Organizational Skills;
- Planning; and/or
- Working Memory.
As a result, Inattentive ADHDers are going to probably struggle with knowing what to focus on and maintaining that attention long-term (Attentional Control). They will likely have trouble tuning out unrelated stimuli and follow a train of thought (Cognitive Inhibition). Their organization is going to be chaotic or non-existent (Organizational Skills). Making and following plans is also very hard (Planning). And their ability to hold information in their minds so they can make decisions and complete tasks is probably impaired (Working Memory).
(I’m not gonna bother explaining how bad it is for us Combined ADHDers. Suffice to say, it sucks.)
I think that if we were to approach ADHD from the view of executive dysfunction, it would suddenly become a lot easier to figure out solutions to the specific problems we experience. Executive functions all interact with each other, so the specific areas we struggle with are impacted based on which executive functions are impaired and just how severely they’re affected.
So consider this the first post in a series about executive dysfunction in ADHD. I’m going to go in-depth into the different executive functions and talk about different ways they interact with each other, and hopefully offer some useful suggestions for how to deal with the resulting problems. I think it’s important to know which executive functions are impaired and how they’re interacting, because that is why systems aren’t one-size-fits-all. The end result looks the same, but the underlying reasons for these problems are different, and that affects the solutions in important ways.
My next post is about Planning and its related executive functions. I have no printable this week, but if you go to the Printables page you’ll find some stuff about executive functioning to get you started.
actuallyadhd.org 