Category: Uncategorized

Executive Dysfunction in ADHD

by Janna, posted in executive dysfunction, Uncategorized

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.

Pinnable image for this post with a picture of a person whose head and shoulders are pixellating and flying away. Or maybe the pixels are coming together to create the person. You decide.

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.

Parenting When You Have ADHD

by Janna, posted in Parenting, Uncategorized

I will be up front on this one: I am not an expert on parenting. I have one child, who is nine years old. I’ve done lots of reading and lots of child care over the years, though, so I hope I can share some good, solid tips that will help us all.

Pinnable image branded for Actually ADHD, with a picture of a parent bear and its baby, with the post title in the lower right.

Most parenting material emphasizes the need to be consistent, and as we all know, ADHD and consistency don’t really mix well.

What I think we can do is embrace a way of relating to our children that is respectful of both their needs and ours. We’ll still mess up and still get distracted, but I think this can have a really positive effect on our families and especially on our children and our parenting.

What is Respectful Parenting?

There are lots of different ways to look at respectful parenting, so I’m just going to explain how I think of it.

The first thing to understand is that it isn’t permissive parenting and it isn’t super strict parenting.

In respectful parenting, we treat our children like human beings, because that’s what they are. We keep their actual abilities in mind and help them where needed, we encourage them to grow and to do things for themselves where they can, and we set limits regarding appropriate behaviour based, again, on their actual abilities and developmental stages.

This isn’t exactly easy.

I find it difficult to enforce the limits I set, often because time isn’t real so bedtime tends to get ignored, but also because I don’t necessarily notice when my kid is doing something I’ve said not to do. However, something I’ve noticed is that, while I am something of a soft touch, my kid does talk to me about important things and comes to me for comfort when it’s needed.

Respectfully Parenting Infants & Toddlers

A couple of things to remember about infants.

  • Babies cry because they need something. It is their only way of communicating, and if they are crying you should definitely check on them to see what’s going on. They are not trying to manipulate you, they literally need you.
  • Babies do not need to be entertained by others the entire time they are awake. It is fine to set them up in a safe place and let them do their own thing for a while. Their primary job as infants is to stay alive and to take in their surroundings.
  • Talk to your baby all the time, in your regular speech. Some “baby talk” is fine, and it’s absolutely natural to use a higher pitched voice at times. But talking normally to children is really beneficial to their language development because they learn how sentences work more quickly.
  • Tell your baby what’s going on. When you’re going to do something, tell them what it is first. “Oh, you need a clean diaper. I’m going to change it for you.” Narrate what you’re doing as you do it. This also helps with language development, and your voice is comforting for them.

As your child ages, their needs will change, and their communication will also change. Again, though, they aren’t trying to manipulate you. Very young children simply do not do this.

Once a child is able to crawl, make sure you have a decent-sized area for them to move around. Make it a safe space for the child (e.g., block electrical outlets, keep cords they could use to pull stuff down on their heads out of reach) and put some age-appropriate toys in the area. Block it off with baby gates so they are contained, and let them play by themselves for a while every day.

Play with your child a few times a day as well. Playing with your child will help your relationship; if all of your interactions are caregiving-related (e.g., bathing, changing diapers, feeding) you will not develop as strong a bond. Playing with your child is great for both of you, though, and you really don’t need to play things you dislike or for longer than you can focus at one time.

Respectfully Parenting Preschoolers

Preschoolers are beginning to really be independent. They want to do things for themselves, but they’re not always able to do so. A preschooler’s job is to learn about the world and to learn their own limitations. Your job as parent is to set limits, to teach them, and to keep them safe.

At this point, you do need to start setting and enforcing limits. It’s okay to choose your battles; if you don’t actually care about something, don’t bother setting a limit around it. Consequences should be related to the infraction, and they need to be pretty immediate. So, for example, if your three-year-old keeps throwing cans on the floor at the grocery store, the cans don’t go where he can reach them.

Something to remember about preschoolers is that they have very little impulse control. They simply react in the moment. They may have some huge feelings when you enforce a limit. That’s okay! Be there with them in that. Tell them you’re there when they’re ready for a hug. Then wait. You can’t teach them why you had to do what you did while they’re upset, so you have to wait. That’s all there is to it.

Now, because preschoolers don’t have impulse control, it is our job as the parent to set up their environment to keep them safe and to make it easy for them to observe limits and follow our rules. If your preschooler pulls all the pots out of the kitchen cupboard “even though you told them not to 500 times” that’s not their fault, it’s yours. The first time they did it and you realized you didn’t want them doing that, you needed to secure the cupboard door so they couldn’t get in anymore.

Preschoolers really enjoy doing things themselves though. So finding safe ways for them to help you with a variety of chores around the house is key. Put a chair or stool up to the sink and let them “wash” the dishes with you. Get them a kid-sized broom so they can help sweep up. If they show interest in it, find a way to get them involved.

Keep doing independent play in a safe area, and keep playing with them a few times a day, just for as long as you can focus at once. They will love it and learn so much!

Respectfully Parenting Older Children

As your child ages, they will gain skills and communicative abilities. They will be able to understand more about limits and consequences, and they will slowly be able to control their impulses better and better.

Note that if your child also has ADHD–likely given how genetics work–some of these things will take longer than others. This is where you having ADHD comes in handy. You can apply your personal experiences and knowledge to your child. Even if their symptoms are different from yours, you will be able to offer them understanding. You can also temper your expectations based on the symptoms they show.

The general principles apply across the lifespan.

  1. Your child is a human being and is worthy of being treated with respect.
  2. Communication is the most important part of your relationship with your child.
  3. Limits need to be appropriate to your child’s age, ability, and developmental stage.
  4. Setting and enforcing limits involves setting your child up for success by changing the environment.
  5. Consequences for ignoring limits need to be directly related to the limit itself.
  6. You cannot reason with someone who is dealing with big emotions.
  7. Big emotions are normal and children have more difficulty than adults in controlling how they respond to having those big emotions.
  8. As with adults, having big emotions doesn’t absolve children of any destructive behaviour they engage in, and once they are calm they need to take responsibility for that and make things right if possible.

If there are specific situations you need help with, please share in the comments and I’ll do my best to offer suggestions!