Executive Function and ADHD

There has been a lot of talk recently about executive function issues and ADHD. What are "executive functions" and how are they related to ADHD?

Executive functions help you exhibit control over your actions so that you can get to a specific goal you wish to achieve. That can be something lofty and long-term, such as "graduate from college" or something small and immediate like "make my lunch." There are five areas of executive functioning that are impacted when you have ADHD. Some find extreme weakness in one area, such as planning, and less in another, such as verbal working memory.

 

Non-verbal working memory is the name given to the way our mind uses visual maps or images to help us be oriented and remember things so we may reach our goals. Visualizing something helps us break it down it into steps so we can imagine the future (as a series of steps) and so we can learn from our past.  Non-verbal working memory also allows us to see ourselves across time. Some with ADHD have trouble creating these images and hanging onto them, making following a sequence difficult or seeing themselves in time difficult.

Verbal working memory. This is the "little voice in your head" that gives you direction - convincing you that it's okay to put something off, telling you to turn right or reminding you that you'll get in trouble if you don't do your homework. We often use this voice to problem solve - "if I do X, will Y happen?" for example. It also plays a role in reading comprehension. Cognitive Behavioral Therapy can help some with ADHD specifically because it helps people learn to actively use their verbal working memory to better reach their goals.

Response inhibition. Your ability to "put on the brakes" is an important part of self-mastery that allows us to think before we act. Those who find impulsivity is one of their primary ADHD symptoms suffer in this area. In addition, response inhibition allows us to delay gratification and resist distraction. Many find that medication can help calm the mind enough to provide better response inhibition.

Emotional and motivational control. Spurts of anger, difficulty keeping oneself from over-reacting and keeping oneself headed towards a long-term goal are all part of executive functioning. When you think of "motivational control" think of "reward" that inspires you to keep going until you get what you want. People with ADHD have a brain chemistry (low dopamine, serotonin and endorphins) that typically does not clearly indicate "reward" in the attention centers of the brain. This leads to having trouble "keeping your eye on the prize" or completing tasks that only reward after a long time (doing well in college so you can get a better job).

Planning and problem solving. Many projects include multiple steps, and sorting out what those steps are and what order they should be in is particularly difficult for many with ADHD. While many people with ADHD consider themselves creative problem solvers because they think outside the box, this is different from organizing a project or problem. Sometimes one of the issue with planning is the weak non-verbal working memory, which makes it hard to "see" or imagine how a complex series of steps will line up.

Lingering executive functioning issues.  Unfortunately, some patients with ADHD find that they still have difficult with executive functioning even after they've gotten some relief from ADHD symptoms with medication and habit changes.  Since executive functioning issues often impact planning and parsing things out, this can create increased tension in a relationship.  There are a few places, such as the Hallowell Center in Sudbury, that are now offering executive functioning training - a specific type of therapy and learning that gets at EF issues.  It's not widespread yet, unfortunately, but the good news is that it exists and will, hopefully, grow.  Right now, at least knowing which executive function issues plague you the most can help therapists focus on helping you devise a treatment plan suited to your specific needs.